Assessment of the Magnitude and Factors Associated with Loss to Follow up in the ART Program of St Peters Hospital, Addis Ababa

Abstract

Background: As much success has been made internationally and nationally on ART rollout and reduction of morbidity and mortality, adherence and long term retention of patients in treatment programs (preventing loss to follow up) has remained a challenge. Objectives This study aimed to assess the magnitude as well as factors associated with loss to follow up in the ART program of St Peters Hospital, Addis Ababa. More over it also described the perspectives of patients on why they discontinue ART. Methods: a cohort of patients who started ART in St Peters Hospital from Megabit 1998 EC (March 2006) to Hidar 2000 EC (November 2007) were retrospectively followed. Data was collected using a pre tested abstraction form from ART intake and follow up national forms on demographic variables, living condition, behaviour, clinical variables and Outcome. The qualitative part used in depth interview of patients and key informants to describe their perspectives. Results: 1095 patients contributed to 1234.36 person years of follow up during which 370 LTFUs occurred. Incidence of LTFU was 300 per 1000 person years (CI: 269, 330). Median time of loss to follow up is 59 days, (IQR: 0.00, 193). Independent predictors of loss to follow up are age (p=.014, HR=.98), functional status (p=.044, HR=.54), baseline CD4 count (p=.037, HR=.998) and Understanding of HIV disease (p=.018, HR=3.325). Reasons for discontinuation of ART include going to holy water, poverty and lack of food, going to the regions for “personal” reasons, and substance use especially among the youth and young adults.