Incidence and Predictors of Loss to Follow-Up Among ART Patients on Follow-Up at Public Health Facilities in Southwest Ethiopia. A Time-to-Event Analysis

Abstract

Background: Loss to follow-up (LTFU) remains a major challenge to successful antiretroviral therapy (ART), contributing to increased morbidity, mortality, and drug resistance, particularly in Sub-Saharan Africa. Evidence on the timing and predictors of LTFU in rural Ethiopia is limited. This study aimed to determine the time to LTFU and its predictors among adults on ART in selected health facilities of Ilu Aba Bor Zone, Southwest Ethiopia. Methods: A retrospective cohort study was conducted among 372 adults living with human immune virus (HIV) on ART at 4 public health facilities from October 2018 to November 2022. Data were extracted from standardized ART forms and patient charts. Kaplan–Meier survival analysis estimated survival probabilities, and Cox proportional hazards regression identified predictors of LTFU, reporting adjusted hazard ratios with 95% confidence intervals (CI). Proportional hazards assumptions were checked using Schoenfeld residuals and log–log plots. Results: Over 6993 person-months of follow-up (median: 19 months), 70 participants (18.8%) were LTFU, mostly within the first year (34.3% in the first 6 months; 32.9% in the second 6 months). Independent predictors included absence of a registered phone number, World Health Organization clinical stage III/IV, noninitiation of cotrimoxazole preventive therapy, nondisclosure of HIV status, and poor or fair adherence. Conclusion: LTFU was common during early antiretroviral. Strengthening patient tracing, promoting disclosure, initiating preventive therapy, and improving adherence support may enhance retention and contribute to achieving human Immune deficiency virus epidemic control targets.