Outcomes and factors affecting mortality and successful tracing among patients lost to follow-up from antiretroviral therapy in Pawi Hospital, Northwest Ethiopia

Moges Agazhe Assemie; Cheru Tesema Leshargie; Pammla Petrucka

doi:10.1186/s41182-019-0181-6

Outcomes and factors affecting mortality and successful tracing among patients lost to follow-up from antiretroviral therapy in Pawi Hospital, Northwest Ethiopia

Trop Med Health. 2019 Nov 6:47:52. doi: 10.1186/s41182-019-0181-6. eCollection 2019.

Authors

Moges Agazhe Assemie¹, Cheru Tesema Leshargie², Pammla Petrucka^{3

4}

Affiliations

¹ 1Department of Public Health, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
² 2Department of Environmental Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
³ 3College of Nursing, University of Saskatchewan, Saskatoon, Canada.
⁴ 4School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania.

Abstract

Background: Loss to follow-up (LTFU) is a major public health problem to antiretroviral therapy (ART) programs in sub-Saharan Africa. Failure to account for patients' LTFU outcomes (self-transfers and restarts) can result in inaccurate reporting of retention in care. In Ethiopia, specifically in the Benishangule Gumuz region, high LTFU reported patients, who were not assessed for their outcomes, are identified as a gap. Therefore, our objective was to determine the outcomes (alive or dead) of patients lost to follow-up (LTFU) from ART and identify factors associated with successful tracing and mortality of these patients.

Results: The proportion of successful tracing was 75.5% (249 of 330). Among the traced patients (n = 249), 22.9% were deceased, 47.8% were on ART, and 29.3% had discontinued treatment. However, the remaining untraceable patients were not locatable due to wrong addresses (53.1%), change of residence (29.6%), and/or lack of functional phone contact (17.3%). Some (32.9%) of the patients discontinued because of negative test results, others (21.9%) for spiritual reasons or side effects (28.8%), and the remaining (16.4%) for other reasons. Tracing using phone numbers (AOR = 2.97, 95% CI 1.57-5.59) and existing long-term follow-up period for ART (AOR = 2.13, 95% CI 1.17-3.88) were strong predictors of successful tracing while not receiving cotrimoxazole preventive therapy (CPT) (AOR = 2.59, 95% CI 1.22-5.39) is a predictor for mortality of patients post-LTFU.

Conclusion: ART programs need to retain current contact information of patients or guardians/friends for tracing. Having phone contact numbers and prolonged lengths of compliance with ART are predictors of successful tracing, while lack of cotrimoxazole preventive therapy is a predictor of mortality. Early tracing of beginners (newly admitted recipients) and updating their detailed information at each follow-up visit is essential.

Keywords: ART tracing; Antiretroviral therapy; Cotrimoxazole preventive therapy; Ethiopia; Loss to follow-up; Mortality.