Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania
Abstract Background Antiretroviral therapy (ART) programs have expanded rapidly, and they are now accessible free of charge, yet "loss to follow-up, LTFU" is still a national public health issue. LTFU may result in treatment failure, hospitalization, increased risk of opportunistic infecti...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08063-9 |
| _version_ | 1797865446849904640 |
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| author | Stella E. Mushy Expeditho Mtisi Eric Mboggo Simon Mkawe Khadija I. Yahya-Malima John Ndega Frida Ngalesoni Aisa Muya |
| author_facet | Stella E. Mushy Expeditho Mtisi Eric Mboggo Simon Mkawe Khadija I. Yahya-Malima John Ndega Frida Ngalesoni Aisa Muya |
| author_sort | Stella E. Mushy |
| collection | DOAJ |
| description | Abstract Background Antiretroviral therapy (ART) programs have expanded rapidly, and they are now accessible free of charge, yet "loss to follow-up, LTFU" is still a national public health issue. LTFU may result in treatment failure, hospitalization, increased risk of opportunistic infections and drug-resistant strains, and shortening the quality of life. This study described the rates and predictors of LTFU among adults living with human immunodeficiency virus (PLHIV) on ART in the Tanga region, Tanzania. Methods A retrospective longitudinal cohort study was conducted between October 2018 and December 2020 in Tanga's care and treatment health services facilities. The participants were HIV adult PLHIV aged 15 years and above on ART and attended the clinic at least once after ART initiation. LTFU was defined as not taking ART refills for 3 months or beyond from the last attendance of a refill and not yet classified as dead or transferred out. Cox proportional hazard regression models were employed to identify risk factors for LTFU. P values were two-sided, and we considered a p < 0.05 statistically significant. Results 57,173 adult PLHIV were on ART of them, 15,111 (26.43%) were LTFU, of whom 10,394 (68.78%) were females, and 4717 (31.22%) were males. Factors independently associated with LTFU involved age between 15 and 19 years (HR: 1.85, 95% CI 1.66–2.07), male sex (HR: 2.00 95% CI 1.51–2.62), divorce (HR: 1.35, 95% CI 1.24–1.48), second-line drug type (HR: 1.13, 95% CI 1.09–1.18), poor drug adherence (HR: 1.50, 95% CI 1.23–1.75), unsuppressed viral load (HR: 2.15, 95% CI 2.02–2.29), not on DTG-related drug (HR: 7.51, 95% CI 5.88–10.79), advanced HIV disease WHO stage III and IV (HR: 2.51, 95% CI 2.32–2.72). In contrast to cohabiting, ART duration < 1 year, and being pregnant showed a reduced likelihood of LTFU. Conclusion A high prevalence of LTFU was observed in this study. Young age, not using DTG-based regimen, WHO clinical stage IV, poor drug adherence, male sex, unsuppressed viral load, divorcee, and second-line regime were independently associated with LTFU. To reduce LTFU, evidence-based interventions targeting the identified risk factors should be employed. |
| first_indexed | 2024-04-09T23:08:05Z |
| format | Article |
| id | doaj.art-0104f792e6b14713a3ea6a9d94dd2fda |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-09T23:08:05Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj.art-0104f792e6b14713a3ea6a9d94dd2fda2023-03-22T10:32:06ZengBMCBMC Infectious Diseases1471-23342023-02-012311910.1186/s12879-023-08063-9Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, TanzaniaStella E. Mushy0Expeditho Mtisi1Eric Mboggo2Simon Mkawe3Khadija I. Yahya-Malima4John Ndega5Frida Ngalesoni6Aisa Muya7Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied SciencesDepartment of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied SciencesAmref Health AfricaAmref Health AfricaDepartment of Nursing Management, School of Nursing, Muhimbili University of Health and Allied SciencesAmref Health AfricaAmref Health AfricaAmref Health AfricaAbstract Background Antiretroviral therapy (ART) programs have expanded rapidly, and they are now accessible free of charge, yet "loss to follow-up, LTFU" is still a national public health issue. LTFU may result in treatment failure, hospitalization, increased risk of opportunistic infections and drug-resistant strains, and shortening the quality of life. This study described the rates and predictors of LTFU among adults living with human immunodeficiency virus (PLHIV) on ART in the Tanga region, Tanzania. Methods A retrospective longitudinal cohort study was conducted between October 2018 and December 2020 in Tanga's care and treatment health services facilities. The participants were HIV adult PLHIV aged 15 years and above on ART and attended the clinic at least once after ART initiation. LTFU was defined as not taking ART refills for 3 months or beyond from the last attendance of a refill and not yet classified as dead or transferred out. Cox proportional hazard regression models were employed to identify risk factors for LTFU. P values were two-sided, and we considered a p < 0.05 statistically significant. Results 57,173 adult PLHIV were on ART of them, 15,111 (26.43%) were LTFU, of whom 10,394 (68.78%) were females, and 4717 (31.22%) were males. Factors independently associated with LTFU involved age between 15 and 19 years (HR: 1.85, 95% CI 1.66–2.07), male sex (HR: 2.00 95% CI 1.51–2.62), divorce (HR: 1.35, 95% CI 1.24–1.48), second-line drug type (HR: 1.13, 95% CI 1.09–1.18), poor drug adherence (HR: 1.50, 95% CI 1.23–1.75), unsuppressed viral load (HR: 2.15, 95% CI 2.02–2.29), not on DTG-related drug (HR: 7.51, 95% CI 5.88–10.79), advanced HIV disease WHO stage III and IV (HR: 2.51, 95% CI 2.32–2.72). In contrast to cohabiting, ART duration < 1 year, and being pregnant showed a reduced likelihood of LTFU. Conclusion A high prevalence of LTFU was observed in this study. Young age, not using DTG-based regimen, WHO clinical stage IV, poor drug adherence, male sex, unsuppressed viral load, divorcee, and second-line regime were independently associated with LTFU. To reduce LTFU, evidence-based interventions targeting the identified risk factors should be employed.https://doi.org/10.1186/s12879-023-08063-9Adult HIV positiveAntiretroviral therapyHIV/AIDSLoss to follow-upPredictorsAfrica |
| spellingShingle | Stella E. Mushy Expeditho Mtisi Eric Mboggo Simon Mkawe Khadija I. Yahya-Malima John Ndega Frida Ngalesoni Aisa Muya Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania BMC Infectious Diseases Adult HIV positive Antiretroviral therapy HIV/AIDS Loss to follow-up Predictors Africa |
| title | Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania |
| title_full | Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania |
| title_fullStr | Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania |
| title_full_unstemmed | Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania |
| title_short | Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania |
| title_sort | predictors of the observed high prevalence of loss to follow up in art experienced adult plhiv a retrospective longitudinal cohort study in the tanga region tanzania |
| topic | Adult HIV positive Antiretroviral therapy HIV/AIDS Loss to follow-up Predictors Africa |
| url | https://doi.org/10.1186/s12879-023-08063-9 |
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