Long-term outcomes and their determinants in patients on antiretroviral treatment in Ethiopia, 2005/6-2011/12: a retrospective cohort study

BACKGROUND: ART programs in many resource-limited settings have expanded treatment towards universal access. Ethiopia is one of the countries that have been scaling up ART towards universal access, but with very few data on long-term outcomes and their determinants. The objective of this study was to identify the level of long-term outcomes and their determinants in patients on ART in Ethiopia.

METHODS: A retrospective cohort study was conducted in three health facilities (two hospitals and one health center) between July and September 2014. Loss to follow-up, death, attrition and retention were the primary outcomes. Data were collected from patient registers and medical records for the period 2005/6 - 2011/12.

RESULTS: A total of 11,731 patients were included in the study. The overall retention rate was 78 per 100 person-months. Retention rates were 82%, 74% and 72% at 24, 60, and 84 months on ART, respectively. Retention was associated with male gender, adolescent age, marital status, advanced HIV disease, illiteracy, and peer-support services; however, long-term retention was associated independently with only male gender (with aHR (0.68 (0.56, 0.77)), married patients (with aHR 0.62 (0.54, 0.72) and peer-support services (with aHR (1.62 (1.58, 1.66).

DISCUSSION AND CONCLUSION: ART programs have lost most of their patients during the first 24 months on ART. It is therefore imperative that HIV/ART programs ensure people are tested, linked to care and initiated on ART early. ART programs should also design and implement interventions, including peer-support services, which are targeted to male, adolescent, unmarried and illiterate patients.