Time to loss follow-up, its predictors, and barriers among HIV infected adolescents after initiation of antiretroviral therapy at Gondar city public health facility, Northwest Ethiopia: A mixed method study

Abstract

Abstract Background: Adolescents aged 10 to 19 years account for approximately 4% of all people living with Human immunodeficiency virus worldwide, but 10% of all new Human immunodeficiency virus infections are occurring among adolescents. Adolescent age is critical because they started to live independently and have access to fulfill their necessities. Current information about LTFU among adolescents on ART is essential for effective treatments. To far, nevertheless, limited research has been done in Ethiopia to address this issue. Objective: The main objective of this study was to assess time to loss follow-up, its predictors, and barriers among HIV infected adolescents after initiation of antiretroviral therapy in Gondar city, Northwest Ethiopia, 2024. Methods: An institution-based retrospective follow-up study with a concurrent qualitative method was conducted from September 2014 to December 2023 at the Gondar city health facilities ART clinic. 648 adolescents were used for quantitative part and 15 (8 key informants and 7 adolescents who lost from ART follow-up) were used for sample of the qualitative part. The data collection was done using the kobo collection toolbox and exported to Stata version 17 for further analysis. A bi-variable and multivariable Cox regression model was fitted to identify predictors of lost to follow-up. The adjusted hazard ratio (AHR) with 95% CI was used to declare significant variables to LTFU in the multivariable analysis. Nvivo software version 15 used for qualitative part. Results: Among the total of six hundered forthy eight study subjects, 93(14.35%, 95% CI: 11.7417.29)

were lost from follow-up during the study period. The incidence rate of LTFU among adolescents with HIV was 4.15 per 100 person-years (95% CI: 3.39-5.09). A fair level of treatment adherence (AHR = 2.53 95% CI: 1.39-4.59), poor treatment adherence (AHR=6.72, 95%: 3.7811.93)

, age of adolescent from 15-19 (AHR = 7.37, 95%: 3.00-18.11), being ambulatory functional status (AHR = 0.38, 95% CI: 0.21-0.67), non-biological caregiver (AHR = 3.56, 95% CI: 1.71-7.41), regimen change (AHR = 3.56, 95% CI: 1.71-7.41), WHO clinical stage III (AHR = 2.20, 95% CI: 1.14–1.37) and IV (AHR = 3.11, 95% CI: 1.10–0.83), were significantly associated with LTFU.Conclusions: The incidence rate of LTFU among adolescents was found to be moderate. Age of adolescent from 15-19, non-biological caregiver, WHO clinical stage III/IV, history of regimen change, poor/fair medication adherence, and being ambulatory functional status were the independent predictors of LTFU