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Background <p>Despite expansion of ART under universal test-and-treat strategies, lost to follow-up remains a major barrier to effective HIV care, leading to treatment interruption, drug resistance, and poor clinical outcomes. Evidence on lost to follow-up in Eastern Ethiopia during the test-and-treat era remains limited. Therefore, this study aimed to assess the incidence and predictors of lost to follow-up in “test and treat era” among adults on Anti-Retroviral Treatment at Public Hospitals in Eastern Ethiopia.</p> Method <p>A retrospective follow-up study was conducted among 863 randomly selected adults newly enrolled in ART after the implementation of the Universal test and treat strategy from November 15, 2016 to March 30, 2024. LTFU was defined as failure to return for ART refill for ≥90 days after the last missed appointment without documented death, transfer-out, or treatment discontinuation. Data were extracted from patient charts using koboTool, and analyzed using STATA (V17.0). Kaplan–Meier survival curve with log-rank test used to compare survival differences, and Cox regression was used to identify predictors of lost to follow-up. Proportional hazard assumptions were checked.</p> Results <p>The median follow-up time was 2.1 years. A total of 229 study participants (26.54%) were lost to follow-up, yielding an incidence rate of 9.9 (95% CI:8.72–11.30) per 100 person-years. Higher hazard of lost to follow-up was observed among those without a contact person (AHR = 1.47;95% CI:1.01–2.12), who had not disclosed HIV status (AHR = 1.51;95% CI:1.03–2.20), presented with WHO clinical stage IV (AHR = 2.86;95% CI:1.57–5.18), baseline CD4 &lt; 200 cells/mm<sup>3</sup> (AHR = 1.61;95% CI:1.03–2.51), opportunistic infection (AHR = 1.44;95% CI:1.02–2.04), no isoniazid preventive therapy (AHR = 1.60;95% CI:1.18–2.18) and poor adherence (AHR = 2.51;95% CI:1.81–3.47). Conversely, BMI &lt; 18.5 kg/m<sup>2</sup> was linked to lower hazard of LTFU (AHR = 0.65;95% CI:0.45–0.92).</p> Conclusion <p>LTFU was relatively high and remains a substantial challenge among adults receiving ART in Eastern Ethiopia during the UTT era. Clinical severity, poor adherence, and limited social support were important predictors of LTFU. Strengthening patient monitoring, adherence counseling, and targeted support for high-risk patients is essential to improve retention in HIV care and progress toward the UNAIDS 95–95-95 targets.</p>

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Incidence and predictors of lost to follow-up in “test and treat era” among adults on ART in Eastern Ethiopia: a retrospective follow-up study

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  • 发表日期：

    2026年7月7日

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  • Mentesenot Seid,
  • Assefa Tola,
  • Alemayehu Tesfaye,
  • Birhanu Shegene,
  • Abdi Gari Negasa,
  • Ribka Mamaru,
  • Kidus Yirgalem,
  • Adisu Birhanu Weldesenbet

摘要

Background

Despite expansion of ART under universal test-and-treat strategies, lost to follow-up remains a major barrier to effective HIV care, leading to treatment interruption, drug resistance, and poor clinical outcomes. Evidence on lost to follow-up in Eastern Ethiopia during the test-and-treat era remains limited. Therefore, this study aimed to assess the incidence and predictors of lost to follow-up in “test and treat era” among adults on Anti-Retroviral Treatment at Public Hospitals in Eastern Ethiopia.

Method

A retrospective follow-up study was conducted among 863 randomly selected adults newly enrolled in ART after the implementation of the Universal test and treat strategy from November 15, 2016 to March 30, 2024. LTFU was defined as failure to return for ART refill for ≥90 days after the last missed appointment without documented death, transfer-out, or treatment discontinuation. Data were extracted from patient charts using koboTool, and analyzed using STATA (V17.0). Kaplan–Meier survival curve with log-rank test used to compare survival differences, and Cox regression was used to identify predictors of lost to follow-up. Proportional hazard assumptions were checked.

Results

The median follow-up time was 2.1 years. A total of 229 study participants (26.54%) were lost to follow-up, yielding an incidence rate of 9.9 (95% CI:8.72–11.30) per 100 person-years. Higher hazard of lost to follow-up was observed among those without a contact person (AHR = 1.47;95% CI:1.01–2.12), who had not disclosed HIV status (AHR = 1.51;95% CI:1.03–2.20), presented with WHO clinical stage IV (AHR = 2.86;95% CI:1.57–5.18), baseline CD4 < 200 cells/mm3 (AHR = 1.61;95% CI:1.03–2.51), opportunistic infection (AHR = 1.44;95% CI:1.02–2.04), no isoniazid preventive therapy (AHR = 1.60;95% CI:1.18–2.18) and poor adherence (AHR = 2.51;95% CI:1.81–3.47). Conversely, BMI < 18.5 kg/m2 was linked to lower hazard of LTFU (AHR = 0.65;95% CI:0.45–0.92).

Conclusion

LTFU was relatively high and remains a substantial challenge among adults receiving ART in Eastern Ethiopia during the UTT era. Clinical severity, poor adherence, and limited social support were important predictors of LTFU. Strengthening patient monitoring, adherence counseling, and targeted support for high-risk patients is essential to improve retention in HIV care and progress toward the UNAIDS 95–95-95 targets.