Incidence and Predictors of Loss to Follow-Up Among Children Attending ART Clinics in Northeast Ethiopia: A Retrospective Cohort Study

Abstract

Background It is known that antiretroviral therapy reduces the transmission of human immunodeficiency virus and AIDS-related morbidity. The coverage of HIV drugs is increasing to control further spread of HIV and children living with HIV are the target groups in using these medications. However, loss to follow-up remains a critical challenge among these groups of the population. The aim of this study was therefore to assess the incidence and predictors of loss to follow-up among children attending antiretroviral therapy clinics. Methods A ten-year institution-based retrospective cohort study was employed among 448 children enrolled in antiretroviral therapy. Data were entered and cleaned using EpiData version 3.1 and then exported to STATA version 14 for further statistical analysis. The Kaplan–Meier survival curve was used to estimate the survival time and the Log rank test was used to compare the survival time between different categories of the explanatory variables. Multivariable Cox proportional hazards model was fitted to identify predictors of loss to follow-up and p-value < 0.05 was considered statistically significant. Results The incidence rate of loss to follow-up was 6.3 per 100 children years of observation. Being male (AHR = 2.1, CI = 1.37, 3.34), aged 1–5 years (AHR = 1.6, CI = 1.05, 2.46), poor adherence to antiretroviral therapy (AHR = 6.6; CI = 4.11, 10.66), fair adherence to antiretroviral therapy (AHR = 2.2; CI = 1.13, 4.20), regimen was not changed (AHR = 4.1; CI = 2.59, 6.45), World Health Organization stage III and IV (AHR = 2.2; CI = 1.40, 3.33) and height for age <−2 z score (AHR = 2.2; CI = 1.43, 3.44) were predictors of loss to follow-up. Conclusion Nearly seven out of 100 HIV-infected children were lost to follow-up from their link to ART clinics within a one-year follow-up. Non-modifiable demographic characteristics, clinical stage and nutritional status, and ART-related variables were associated with children’s loss to follow-up. Therefore, close monitoring of the “at risk” groups might decrease the rate of loss to follow-up. Improving adherence to antiretroviral therapy and nutritional support are also recommended.