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Open Access Research article

Predictors of loss to follow-up before HIV treatment initiation in Northwest Ethiopia: a case control study

Ismael Ahmed1*, Salem T Gugsa2, Seblewengel Lemma3 and Meaza Demissie3

Author Affiliations

1 University of Gondar and Addis Continental Institute of Public Health, P.O. Box 180432, Addis Ababa, Ethiopia

2 Department of Global Health, University of Washington, 901 Boren Avenue, Suite 1100, Seattle, Washington 98104, USA

3 Addis Continental Institute of Public Health, P.O. Box 26751/1000, Addis Ababa, Ethiopia

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BMC Public Health 2013, 13:867  doi:10.1186/1471-2458-13-867

Published: 22 September 2013

Abstract

Background

In Ethiopia, there is a growing concern about the increasing rates of loss to follow-up (LTFU) in HIV programs among people waiting to start HIV treatment. Unlike other African countries, there is little information about the factors associated with LTFU among pre-antiretroviral treatment (pre-ART) patients in Ethiopia. We conducted a case–control study to investigate factors associated with pre-ART LTFU in Ethiopia.

Methods

Charts of HIV patients newly enrolled in HIV care at Gondar University Hospital (GUH) between September 11, 2008 and May 8, 2011 were reviewed. Patients who were “loss to follow-up” during the pre-ART period were considered to be cases and patients who were “in care” during the pre-ART period were controls. Logistic regression analysis was used to explore factors associated with pre-ART LTFU.

Results

In multivariable analyses, the following factors were found to be independently associated with pre-ART LTFU: male gender [Adjusted Odds Ratio (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) and 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. In addition, patients whose next visit date was not documented on their medical chart [AOR = 241.39 (95% CI: 119.90, 485.97)] were more likely to be LTFU.

Conclusion

Our study identified various factors associated with pre-ART LTFU. The findings highlight the importance of giving considerable attention to pre-ART patients’ care from the time that they learn of their positive HIV serostatus. The completeness of the medical records, the standard of record keeping and obstacles to retrieving charts also indicate a serious problem that needs due attention from clinicians and data personnel.

Keywords:
Pre-antiretroviral treatment loss to follow-up; HIV patients; Case control; Ethiopia; Africa