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Table 1 Characteristics of included articles (n = 45)

From: HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis

Authors and year(n)Study designStudy areaMajor objectives of the studyMajor findings
Takele et al. [24]542Retrospective cohortBichena Health center, Northwest, EthiopiaTo assess the time to lost follow up and its predictors among adult HIV positive people receiving ARTPrevalence of lost to follow up was 40.8% and incidence was 13.45/100 person years. Predictors of loss to follow up were:
➢ Poor drug adherence AHR, 2.91 (2.08–4.09),
➢ TDF based base line regimen AHR, 1.63 (1.20–2.20),
➢ baseline regimen change AHR, 1.79 (1.08–2.97)
➢ Poor functional status AHR, 2.71 (2.01–3.66)
Yigzaw et al. [22]484Retrospective cohortDebre Markos referral hospital, Northwest, EthiopiaTo determine the incidence and predictors of loss to follow up among HIV positive adults on ARTAbout 17.36% of the individual were lost from ART follow-up. Rate of lost to follow-up was found to be 3.7 per 100 person- year’s observation and 30.95% occurred within the last years of follow up. The predictors for LTFU were:
➢ ART Regimen [(AZT-3TC-NVP, AHR (95% CI = 2.79 (1.07, 7.23)),
➢ AZT-3TC-EFV, AHR (95% CI) = 3.14 (1.13, 8.08)
➢ TDF-3TC-EFV, AHR (95%CI = 9.3 (3.75, 23.8)],
➢ good ART adherence [AHR (95%CI) = 0.54 (0.3, 0.9)],
➢ WHO clinical stage IV [AHR: 95%CI = 2.75 (1.23–6.16)],
➢ Urban residence [AHR: 95%CI) = 0.6 (0.37–0.99),
➢ no cell phone [AHR: 95%CI) = 1.9 (1.14–3.4)]
➢ Age categories [(35–44 years (AHR(95%CI) = 0.32 (0.15–0.67)
➢ 45+ years (AHR (95%CI) =0.33 (0.13–0.83)].
Seifu et al. [16]1439Retrospective cohortKaramara general hospital, Jigjiga town, Eastern EthiopiaTo measure incidence and predictors of loss to follow up among adult ART clients.The incidence rate of loss to follow up in the cohort was 26.6% (95% CI; 18.1–29.6) per 100 person months. Factors associated with LTFU were;
➢ Patients with male sex [HR: 2.1CI;(1.3–3.4)]
➢ patients whose next appointment weren’t recorded [HR: 1.2, 95% CI; (1.12–1.36)]
➢ patients who did not disclose their status to any one [HR: 2.8, 95% CI; (2.22–5.23)]
Berheto et al. [23]8009Retrospective cohortFour health centers and 2 hospitals in Southern, EthiopiaTo examine the effects of mental health training on HIV patient retention in care.The incidence of attrition was 6.5 per 100 person-years
➢ 21% higher in the unexposed group (HR 1.21; 95% CI 1.1, 1.3)
➢ Retention in care was significantly higher in the mental health trained group. Independent risk factors for attrition were;
➢ WHO clinical staging III/IV
➢ Tuberculosis co-infection
➢ the male gender
➢ Poor functional status
Assemie et al. [17]602Retrospective cohortPawi General Hospital, northwest EthiopiaTo assess incidence of lost-to-follow-up and its predictors among HIV-positive adults after initiation of ARTCumulative incidence of lost-to-follow-up after ART initiation was high, 11.6 (95% CI 9.8–13.7) per 100 adult-years follow-up time. Independent significant predictors of lost to follow up were;
➢ Being aged 15–28 years (AHR = 0.44; 95% CI 0.24–0.83)
➢ being on WHO clinical stage IV (AHR = 2.09; 95% CI 1.02–3.13)
➢ Receiving isoniazid preventive therapy (AHR = 0.11; 95% CI 0.06–0.18).
Adewo et al. [25]652Retrospective cohortTepi General Hospital in South West assess factors related with time to attrition179 patients were lost to follow up and 37 patients died, contributing to an overall attrition of 33.13%. During the early six months the attrition rate was 89.8%.
➢ Not starting cotrimoxazole prophylaxis (AHR = 1.51, 95% CI, 1.02–2.25)
➢ being co-infected with tuberculosis (TB) (AHR = 2.16, 95%CI, 1.35–3.45)
➢ living further than 10 km away from the hospital (AHR = 1.44, 95%CI, 1.07–2.0)
➢ Not disclosed status of HIV (AHR = 3.04) were factors significantly associated with time to attrition.
Gesesew et al. [26]3607Retrospective cohortJimma University
Teaching Hospital, Western Ethiopia
to assess prevalence, trend and risk factors for ART discontinuation1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005.
➢ Being a female (AOR = 2.1, 95%CI: 1.7–2.8),
➢ Having an immunological failure (AOR = 2.3, 1.9–8.2)
➢ having tuberculosis/HIV co-infection (AOR = 1.5, 1.1–2.1)
➢ No previous history of HIV testing (AOR = 1.8, 1.4–2.9) were the risk factors for ART discontinuation.
Bucciardini et al. [53]1198prospective cohortIn seven health facilities in Tigray in northern Ethiopia.To determine predictors of patient attrition after 12 months in careKaplan–Meier estimates of retention in care were 83.9, 82.1 and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up (6.8%), transferred-out patients (9.5%) and mortality (4.4%). Factors associated with attrition were;
➢ Male sex
➢ CD4 count < 200 cells/μL
➢ Type of health facility
Wilhelmson et al. [27]383retrospective cohortAdama Hospital, central EthiopiaTo determine retention in care among patients receiving second-line ART in a public hospitalAt the end of study follow-up, 80.5% of patients remained in care (adults and adolescents 79.8%; children 85.7%). LTFU among adults and adolescents was associated with;
➢ baseline CD4 cell count 100 cells/mm3 and
➢ First-line regimen failure that was not confirmed by HIV RNA testing.
Tiruneh et al. [10]222retrospective cohortAddis Ababa, Central EthiopiaTo assessed how well patients stay in care and explored factors associated with retentionThirty percent were LTFU by end of the study; the median time to LTFU was 1675 days. Higher risk of LTFU was associated with:
➢ Baseline CD4 counts < 100 and > 200 cells/uL (HR = 1.62; 95%CI: 1.03–2.55; and HR = 2.06; 95%CI: 1.15–3.70, compared with patients with baselineCD4 counts of 100–200 cells/uL.
➢ Bedridden at baseline (HR = 2.05; 95%CIs [1.11–3.80])
➢ Those with no or only primary education (HR = 1.50; 95%CIs [1.00–2.24]) were more likely to be LTFU.
➢ The qualitative data revealed that fear of stigma, care dissatisfaction, use of holy water, and economic constraints discouraged retention in care.
Megerso et al. [49]1248Case controlOromia, central and western Ethiopiaidentifying correlates of loss to follow-up in ART among adult patientsfactors which increased the risk of loss to follow-up in ART were;
➢ Age 15–24 years [AOR], 19.82 95% CI: 6.80, 57.73);
➢ day laborers (AOR, 5.36; 95% [CI]: 3.23, 8.89),
➢ rural residents (AOR, 2.35; 95% CI: 1.45, 3.89),
➢ WHO clinical stage IV (AOR, 2.29; 95% CI: 1.45, 3.62),
➢ Baseline CD4,350 cells/mL (AOR, 2.06; 95% CI: 1.36, 3.13),
➢ suboptimal adherence of ART (AOR, 7.42; 95% CI: 1.87, 29.41)
Mitiku et al. [28]346retrospective cohortSouth and North Wollo, Oromia special zone, Northern EthiopiaTo determine levels and determinants of LFU under Option B+ among pregnant and breastfeeding womenOverall, 57 (16.5%) women were LTFU. The cumulative proportions of LTFU at 6, 12 and 24 months were 11.9, 15.7 and 22.6%, respectively.
➢ The risk of LTFU was higher in younger women 18 to 24 years than 30 to 40 years: (AHR = 2.3; 95% (CI): 1.2 to 4.5)
➢ In those attending hospitals compared to those attending health centers (AHR: 1.8; 95% CI: 1.1 to 3.2),
➢ In patients starting ART on the same day of diagnosis (AHR: 1.85; 95% CI: 1.1 to 3.2)
➢ Missing CD4 cell counts at ART initiation (AHR: 2.3; 95% CI: 1.2 to 4.4).
Teshome et al. [54]1173retrospective cohort22 hospitals and 25 health centers in southern Ethiopia.compared death and loss to follow-up (LTFU) rates among ART patients among patients in hospitals and health centers24.6% were either dead or LTFU, resulting in a retention rate of 75.4%. The death rates were 3.0 and 1.5 and the LTFU rate were 9.0 and 10.9 per 100 person-years of observation in health centers and hospitals, respectively. The competing-risk regression model showed that;
➢ The longer gap between testing and initiation of ART,
➢ body mass index > 18.5 (AHR, 0.58 (95% CI, 0.38–0.91)
➢ advanced WHO clinical stage
➢ No Isoniazid prophylaxis (AHR, 1.90 (95% CI, 1.10–3.23)
➢ Age 26–39 (AHR, 0.59 (95% CI, 0.42–0.83)
➢ Secondary and above educational compared to no education status (AHR, 0.58 (95% CI, 0.39–0.67) were independently associated with LTFU.
➢ Moreover, baseline tuberculosis disease, poor functional status /bed ridden (AHR, 5.35 (95% CI, 1.67–17.1), and follow-up at a health center were associated with an elevated probability of death.
Dessalegn et al. [50]727Case controlWukro primary public hospital, Northern Ethiopiato assess the magnitude and predictors of loss to follow-up among adult ART clients11% of them were loss to follow up. Factors associated with LTF were:
➢ Absence of bereavement concern AOR, 0.12 (0.046,0.30)
➢ not provided Isoniazide (INH) prophylaxis AOR, 3.04 (1.3, 7.3),
➢ The presence of side effects AOR, 12.34 (4.86, 31.35)
➢ Earlier (< 36 month) periods after ART AOR, 23.54 (8.87, 62.45)
Melaku et al. [30]93,418retrospective cohortNation wideTo measure trend and treatment outcomes of HIV treatment24% of patients were LTF before ART initiation. Among those initiating ART, attrition was 30% after 36 months, with most occurring within the first 6 months. Recorded death after ART initiation was 6.4 and 9.2% at 6 and 36 months, respectively, and decreased over time. Younger age, male gender, never being married, no formal education, low CD4+ cell count, and advanced WHO stage were associated with increased LTFU. Death was lower among younger adults, females, married individuals, those with higher CD4+ cell counts and lower WHO stage at ART initiation
Shaweno et al. [29]626retrospective cohortSheka Zonal Hospital, southern Ehtiopiatime when LTFU occurs and the associated factors among adults enrolled in pre-ART careA total of 178 (28.4%) pre-ART patients were lost to Follow up, 93% of which occurred within the first six months. The independent predictors included:
➢ Not having been started on cotrimoxazole prophylaxis [AHR] = 1.77, 95%, [CI], 1.12–2.79),
➢ baseline CD4 count of or above 350 cells/mm3 (AHR = 1.87, 95%CI, 1.02–3.45)
➢ An undisclosed HIV status (AHR = 3.04, 95%CI, 2.07–4.45).
Mekuria et al. [31]836retrospective cohortAddis Ababa, Central EthiopiaTo describe the proportion of patients who are retained in HIV care and characterize predictors of attrition among HIV-infected adults receiving cARTNearly 80% (95%CI: 76.7, 82.1) of the patients were retained in care in the first 3 and half years of antiretroviral therapy. After successfully tracing more than half of the LTFU patients, the updated one year retention in care estimate became 86% (95% CI: 83.41, 88.17%).
➢ Severe immune deficiency at enrolment in care/or at ART initiation
➢ ‘bed-ridden’ or ‘ambulatory’ functional status at the start of ART predicted attrition.
Bucciardini et al. [55]563Prospective cohortTigray, Northern EthiopiaWe report data on retention in care and its associated determinantsOverall 85.1% of their patients retained after one year from starting ART. Loss to follow-up (5.5%) and transfers to other health facilities (6.6) were the main determinant of attrition. The factors associated with retention were;
➢ The type of health facilities,
➢ Active TB (HR 1.72, 95% CI: 1.23–2.41)
➢ Male gender (AHR, 1.34 (955 CI, 1.04 to 1.7)4
Assefa et al. [32]11,371retrospective cohortthree health facilities in Addis Ababa, Central EthiopiaTo identify the level of long-term outcomes and their determinants in patients on ART in EthiopiaRetention rates were 82, 74, and 72% at 24, 60, and 84 months on ART, respectively. Retention was associated with:
➢ Male sex, adolescent age, marital status, advanced HIV disease, Illiteracy and peer-support services
➢ However, long-term retention was associated independently with:
➢ only male sex (AHR) 0.68 (0.56 to 0.77)]
➢ married patients [with AHR 0.62 (0.54 to 0.72)]
➢ peer-support services [with AHR 1.62 (1.58 to 1.66)]
Berheto et al. [61]2133retrospective cohortMizan-Aman General Hospital in the Southern Ethiopiaaimed at determining the incidence and risk factors for LTFU in HIV patients on ARTAround 574 (26.7%) patients were defined as LTFU. The cumulative incidence of LTFU was 8.8 (95% CIs 8.1–9.6) per 1000 person months.
➢ Patients with regimen substitution (HR 5.2; 95% CIs 3.6–7.3),
➢ Never took isoniazid (INH) prophylaxis (HR 3.7; 95% CIs 2.3–6.2),
➢ adolescent (HR 2.1; 95% CIs 1.3–3.4),
➢ Had a baseline CD4 count < 200 cells/mm3 (HR 1.7, 95% CIs 1.3–2.2) were at higher risk of LTFU, WHO clinical stage III (HR 0.6; 95% CIs 0.4–0.9) and IV (HR 0.8; 95% CIs 0.6–1.0) patients at entry were less likely to be LTFU than clinical stage I patients
➢ Ambulatory and bedridden functional status were less affected by LTF than working groups ((HR, 0.4 (0.3,0.6) and HR, 0.7 (0.5, 0.9)) respectively
➢ There was no significant difference in risk of LTFU in males and females in this study
Reepalu et al. [34]678Prospective cohortFive health centers in Adama, Central Ethiopiacompared virological suppression (VS) rates, mortality, and retention in care in HIV-positive adults receiving careNo difference in retention in care between TB and non-TB patients was observed during follow-up; 25 (3.7%) patients died, and 17 (2.5%) were lost to follow-up (P = .30 and P = .83, respectively).
Tadesse et al. [33]520retrospective cohortTigray, Northern EthiopiaTo determine loss to follow up and its determinants51 (9.8%) were loss giving a LTFU rate of 8.2 per 100 person- years. From these LTFU, 21 (41%) occurred within the first Six months of ART initiation. The independent predictors of LTFU of patient were:
➢ being smear positive pulmonary TB [AHR (95% CI) = (2.05 (1.02, 4.12)],
➢ male gender [AHR (95%CI) = (2.73 (1.31, 5.66)],
➢ regiment AZT-3TC-NVP [AHR (95%CI) = (3.47 (1.02,11.83)] and
➢ Weight ≥ 60 kg [AHR (95% CI) = (3.47 (1.02, 11.83)].
Wubshet et al. [59]3012Cross sectionalGondar, Northwest EthiopiaTo determine the outcome and factors associated with LTF among HIV patientsOut of the 551 patients LTF, 486 (88.20%) were successfully tracked. Death was the most common reason accounted for 233 (47.94%) of the lost to follow-up. Reasons for non-deaths losses include: stopped antiretroviral treatment due to different reasons, 135 (53.36%), and relocation to another antiretroviral treatment program by self- transfer, 118 (46.64%). The rate of mortality in the first six months was 72.12 per 100 person-years (95% CI: 61.80–84.24) but this sharply decreased after 12 months to 7.92 per 100 person-years (95% CI: 4.44–14.41). Baseline clinical characteristics were strongly associated with outcome such as presence of tuberculosis infection at ART initiation, functional status (both ambulatory and bed ridden); CD4 cell count, 100 cells/mL, and WHO stage III and IV were strongly associated with mortality. On the other hand, male sex, bedridden functional status and residence outside Gondar town were significantly associated with non-death losses.
Asefa et al. [51]236Case controlNekemte Hospital, western Ethiopiato assess determinants of defaulting from antiretroviral treatmentAfter controlling for possible confounders,
➢ living far from the facility (out of the town) (AOR = 4.1; 95%CI 1.86 to 9.42),
➢ dependent patients for source of food [AOR = 13.9; 95%CI 4.23 to 45.99],
➢ patients with mental status not at ease [AOR = 4.7; 95%CI 1.65 to 13.35],
➢ patients whose partners were HIV negative [AOR = 5.1; 95%CI 1.59 to 16.63],
➢ patients whose partners HIV status were unknown or not tested [AOR = 2.8; 95%CI 1.23 to 6.50]
➢ Patients that fear stigma [AOR = 8.3; 95%CI 2.88 to 23.83] were statistically significant association.
Ahmed et al. [8]1817Case controlGondar, Northwest EthiopiaTo investigate factors associated with pre-ART LTFU in Ethiopia.factors were found to be independently associated with pre-ART LTFU:
➢ male gender (AOR) = 2.00 (95% CI: 1.15, 3.46)]
➢ higher baseline CD4 cell count (251–300 cells/μl [AOR = 2.64 (95% CI: 1.05, 6.65)]; 301–350 cells/μl [AOR = 5.21 (95% CI: 1.94, 13.99)], and > 350 cells/μl [AOR = 12.10 (95% CI: 6.33, 23.12)] compared to CD4 cell count of ≤200 cells/μl)
➢ Less advanced disease stage (WHO stage I [AOR = 2.81 (95% CI: 1.15, 6.91)] compared to WHO stage IV).
➢ Married patients [AOR = 0.39 (95% CI: 0.19, 0.79)] had reduced odds of being LTFU.
➢ Patients whose next visit date was not documented on their medical chart [AOR = 241.39 (95% CI: 119.90, 485.97)]
Wubshet et al. [60]3012SurveyGondar, Northwest Ethiopiato evaluate mortality, loss to follow up, and retention in care61.4% of the patients were retained on treatment, 10.4% died, and 31.4% were lost to follow up. Fifty-six percent of the deaths and 46% of those lost to follow up occurred in the first year of treatment.
➢ Male gender (AHR) 3.26; 95% CI: 2.19–4.88)
➢ CD4 count≤200 cells/μL (AHR 5.02; 95% CI: 2.03–12.39),
➢ tuberculosis (AHR 2.91; 95% CI: 2.11–4.02);
➢ bed-ridden functional status (AHR 12.88; 95% CI: 8.19–20.26) were predictors of mortality,
➢ Whereas only CD4 count < 200 cells/μL (HR = 1.33; 95% CI: (0.95, 1.88) and ambulatory functional status (HR = 1.65; 95% CI: (1.22, 2.23) were significantly associated with LTF.
Assefa et al. [36]37,466retrospective cohortNationwide studyIntended to evaluate the outcomes of the ART services in 55 health facilities in Ethiopia.Health facilities were able to retain 29,893 (80%), 20,079 (74%) and 5069 (68%) of their patients after 6, 12 and 24 months on ART, respectively. Retention rates vary across health facilities, ranging from 51 to 85% after 24 months on ART. Mortality was 5, 6 and 8% after 6, 12 and 24 months on ART. More than 79% of patients with available CD4-cell counts had a baseline CD4-cell counts less than 200 cells per micro-liter of blood.
Balcha et al. [37]1709Prospective cohortOromia regionto compare the outcomes of antiretroviral therapy (ART) between hospital and health center levels1044 (61%) remained alive and were on treatment after 24-month follow-up. In all, 835 (57%) of ART patients at hospitals and 209 (83%) at health centers were retained in the program. Of those who were alive and receiving ART, 79% of patients at health centers and 72% at hospitals were clinically or immunologically improving. In addition, 331 (23%) patients at hospitals were LFTU as compared to 24 (10%) of patients at health centers (relative risk [RR] at 95% confidence interval [CI]: .358 [.231–.555]). While 11% was the mortality rate at hospitals, 5% of patients at health centers also died (RR at 95% CI: .360 [.192–.673]).
Deribe et al. [52]1270Case controlJimma University
Teaching Hospital, western Ethiopia
To determine the prevalence of and factors associated with defaulting from antiretroviral treatment (ART)Of 1270 patients who started ART, 915 (72.0%) were active ART users and 355 (28.0%) had missed two or more clinical appointments. The latter comprised 173 (13.6%) defaulters, 101 (8.0%) who transferred out, 75 (5.9%) who died, and 6 (0.5%) who restarted ART. Reasons for defaulting were unclear in most cases. Reasons given were; loss of hope in medication, lack of food, Mental illness, holy water, no money for transport and other illnesses. Tracing was not successful because of incorrect address on the register in 61.6% of the cases.
➢ Taking hard drugs (cocaine, cannabis and IV drugs)
➢ excessive alcohol consumption
➢ Being bedridden,
➢ living outside Jimma town
➢ Having an HIV negative or unknown HIV status partner were associated with defaulting ART.
Abebe et al., [18]640Retrospective cohortDebre Markos referral hospital, Northwest EthiopiaTo determine Survival status of HIV positive adults on antiretroviral treatment640 patient cards (379 alive and 261 death) adult HIV infected individuals were included in the study. General mean estimated survival time of patients after HAART initiation was improved.
Significant predictors of mortality after HAART initiation were: Lower
baseline hemoglobin; Ambulatory and bed ridden functional status;
Poor ART adherence; Advanced WHO clinical stage; Absence of
recent TB prophylaxis; Unrecognized side effects; Persistent
unexplained chronic diarrhea (> 1 month)
Ahmed et al. [47]503Retrospective cohortAfar, north-east Ethiopia.assessed the incidence of tuberculosis
(TB) and its predictors among adults living with HIV/AIDS
40 transfer out to other health facilities
13 died
21 loss to follow up
258 did not develop TB
119 developed TB
Mekonnen et al. [46]1533Retrospective cohortJimma hospital southwest Ethiopiato assess reasons and predictors of regimen change from initial
highly active antiretroviral therapy
One in two (47.7%) adults changed their antiretroviral therapy regimen. Patients who were above the primary level of education [Hazard ratio (HR) 1.241 (95% CI 1.070–1.440)] and with human immunodeficiency virus/Tuberculosis co-infection [HR 1.405 (95% CI 1.156–1.708)] had the higher risk of regimen change than their comparator.
Chaka et al. [40]248Retrospective cohortAdama, Central Ethiopiato assess Option B+
PMTCT service intervention outcomes.
Loss to follow-up from the Option B+ continuum was 10 (4.2%).
Tadege [41]1512Retrospective cohortMettu Karl Hospital, southwest Ethiopiato determine the major risk factors of antiretroviral therapy dropoutthe risk of dropout for patients with primary education status was
10.58% greater as compared to illiterate (p < 0.0110). The probability of dropout for patients with marital status separated was about 16.82% higher than those patients with marital status divorced (p < 0.0070). Being merchant, farmer and daily labour had a greater risk of dropout as compared to a housewife.
Gezea et al. [39]305Retrospective cohortMekelle, Northern Ethiopiaaimed at investigating the incidence and predictors of LTFU of TB/HIV co-infected patients45 of 305 (14.8%) of TB/HIV co-infected adults were LTFU with an incidence rate of 4.5 new LTFUs per 100 Person Years (PYs) and a median follow up time of 3.1 years (Interquartile Range (IQR): 0.8–5.3 Years). Hemoglobin level ≤ 11.0 g/dl (AHR = 2.660; 95%CI: 1.459–4.848), and any history of OI/s (AHR = 3.795; 95%CI: 1.165–12.364) were risk factors of LTFU. While, adverse drug events (AHR = 0.451; 95%CI: 0.216–0.941), TB treatment completion (AHR =0.121; 95% CI: 0.057–0.254), and being on Isoniazid Preventive Therapy (IPT) (AHR = 0.085; 95%CI: 0.012–0.628) had protective effect against LTFU.
Mekonnen et al. [38]569Retrospective cohortGondar, Northwest Ethiopiato estimate the incidence of lost to follow up from ART care and identify the associated factors among HIV infected patients after first-line ART initiationThe overall incidence rate of lost to follow up was 12.26 per 100 person years (95% CI (10.61–14.18)). Being underweight (<  18.5 kg/m2) (AHR, 1.52, 95% CI 1.01–2.28), jobless (AHR, 2.22, 95% CI 1.2–4.11), substance abuser (AHR, 1.84 95% CI 1.19–2.86), having sub-optimal adherence (fair/poor) (AHR 6.33, 95% CI (3.90–10.26)), not receiving isoniazid prophylaxis (AHR 2.47, 95% CI (1.36–4.48)), ambulatory functional status (AHR 1.94, 95% CI (1.23–3.06)), having opportunistic infections (AHR, 1.74 95% CI 1.11–2.72), having CD4 count 201–349 cells/μL (AHR 0.58, 95% CI (0.38–0.88)) were found to be significant predictors of lost to follow up from ART service.
Damitew et al. [44]784Retrospective cohortKharamara hospital, Somalia, Eastern Ethiopiato assess survival and identify predictors of death in adult HIV-infected patients initiating ARTThere were 87 (11.1%) deaths yielding an overall mortality rate of 5.15/100 PYO (95% CI: 4.73–6.37). The estimated mortality was 8.4, 9.8, 11.3, 12.7 and 14.1% at 6, 12, 24, 36 and 48 months respectively. The independent predictors of death were single marital status (AHR: 2.31; 95%CI: 1.18–4.50), a bedridden functional status (AHR: 5.91; 95%CI: 2.87–12.16), advanced WHO stage (AHR: 7.36; 95%CI: 3.17–17.12), BMI < 18.5 Kg/m2 (AHR: 2.20; 95%CI: 1.18–4.09), CD4 count < 50 cells/μL (AHR: 2.70; 95%CI: 1.26–5.80), severe anemia (AHR: 4.57; 95%CI: 2.30–9.10), and TB co-infection (AHR: 2.30; 95%CI: 1.28–4.11)
Ayele et al. [43]730Retrospective cohortKembata and Hadiya zonesTo assesses treatment outcomes and its determinants for HIV patients on ARTA total of 92 (12.6%) patients died, 106 (14.5%) were lost to follow-up, and 109 (15%) were transferred out. Sixty three (68%) deaths occurred in the first 6 months of treatment. The median survival time was 25 months with IQR [9, 43]. After adjustment for confounders, WHO clinical stage IV [HR 2.42; 95% CI, 1.19, 5.86], baseline CD4 lymphocyte counts of 201 cell/mm3 and 350 cell/mm3 [HR 0.20; 95% CI; 0.09–0.43], poor regimen adherence [HR 2.70 95% CI: 1.4096, 5.20], baseline hemoglobin level of 10 g/dl and above [HR 0.23; 95% CI: 0.14, 0.37] and baseline functional status of bedridden [HR 3.40; 95% CI: 1.61, 7.21] were associated with five year survival of HIV patients on ART.
Bezabh et al. [57]337Retrospective cohortBahrdar and Gondar, northwest Ethiopiato determine patient, regimen, disease, patient-provider, and healthcare-related factors associated with adherence with ART130 (75.6%) had ≥95% adherence. In the multivariate analyses, a higher baseline BMI (OR, 1.2; 95% CI 1.0, 1.4) and use of reminder devices (OR, 9.1; 95% CI 2.0, 41.6) remained positively associated with adherence
Awoke et al. [42]2386Retrospective cohortGondar, northwest Ethiopiato determine and compare the long-term response of patients on nevirapine and efavirenz70.58% were retain in clinical care
302 were transfer out to other health facilities
230 were lost to follow up
170 were dead
Mekuria et al. [48]870Retrospective cohortAddis Ababa, Central EthiopiaTo investigated virological suppression levels and its predictors of detectable viraemiaA total of 656 (75.4%) patients, who were alive, were retained in HIV care.
Virological suppression levels can be high in an established ART programme in a resource-limited setting
Assefa et al. [9]20,099Retrospective cohortNation wideTo reviews the performance of the ART program in EthiopiaThe ART program has been successful over several critical areas: (1) ART coverage improved from 4 to 54%; (2) the median CD4 count/mm3 at the time of ART initiation increased from 125 in 2005/ 6 to 231 in 2012/13; (3) retention in care after 12 months on ART has increased from 82 to 92%. In spite of these successes, important challenges also remain: (1) ART coverage is not equitable: among regions (5.6–93%), between children (25%) and adults (60%), and between female (54%) and male patients (69%); (2) retention in care is variable among regions (83–94%); and, (3) the shift to second-line ART is slow and low (0.58%).
Lifson et al. [56]142Prospective cohortArbaminchThe effects of community based support on patient retentionCommunity health support workers (CHSWs) provided HIV and health education, counseling/social support, and facilitated communication with the HIV clinics. With 7 deaths and 3 transfers, the 12-month retention rate was 94% (95% CI ¼ 89–97%), and no client was LTFU in the project. Between enrollment and 12 months, clients had significant (P < .001) improvements in HIV knowledge (17% increase), physical and mental quality of life (81 and 21% increase), internalized stigma (97% decrease), and perceived social support (24% increase).
Tadege [45]600Retrospective cohortIllubaburTime to death predictorsThe risk of death for patients who lived with tuberculosis was about 2.872-fold times higher than those patients who were negative. Most of the HIV/AIDS patients on antiretroviral therapy were died in a short period due to tuberculosis comorbidity, began with lower amount of CD4, being underweight, merchant, and being on WHO clinical stage IV
Telele et al. [58]874Prospective cohortNation wideTo predict first-line ART outcome after 6 and 12 monthsThe treatment failure rates were 23.3 and 33.9% at 6 and 12 months, respectively. The odds of LTFU at month 6 increased with baseline functional disabilities, WHO stage III/IV, and CD4 cells < 50/μl. At month 6, 131/874 (15.0%) patients were dead (n = 62) or LTFU due to other reasons (n = 69).
Assesfa et al. [12]334,819Retrospective cohortNation wideWe aimed to analyze the ART program in Ethiopia.While ART was being scaled up, retention was recognized to be insufficient. To improve retention, a second wave of interventions, related to programmatic, structural, socio-cultural, and patient information systems, have been implemented. Retention rate increased from
77% in 2004/5 to 92% in 2012/13.
Total number of participants 546,250
  1. Key: AHR Adjusted Hazard Ratio, LTFU Loss to follow up