Gesesew Hailay
Flinders University, Australia
Title: ART discontinuation in HIV-infected adults in Ethiopia, 2003-2015: Prevalence, trend & risk factors
Biography
Biography: Gesesew Hailay
Abstract
Background: Antiretroviral therapy (ART) discontinuation obscures achievements for the UNAIDS treatment targets 2 and 3. Nevertheless, the magnitude, trend and its risk factors are not explored contextually. We carried out historical data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia. Methods: 12 years retrospective cohort analysis was performed with 4900 HIV-infected adults between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART Discontinuation could be lost to follow-up, defaulting and/or stopping medication while remaining in care. 10 years trends for ART discontinuation was described using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern. Results: In total, 4900 adults enrolled on ART, of whom 1090 (22.4%) had discontinued, 954 (19.6%) had transferred out, 300 (6.2%) had died, and the remaining 2517 (51.8%) were alive and on ART between 2003 and 2015. The recent trend of ART discontinuation showed an upward direction reaching a peak in 2004 and 2005 with 10%. Being female (AOR=2.1, 95%CI: 1.7-2.8), having an immunological failure (AOR=2.3, 1.9-8.2), having tuberculosis/HIV co-infection (AOR=1.5, 1.1-2.1) and no previous history of HIV testing (AOR=1.8, 1.4-2.9) were the risk factors for ART discontinuation. Conclusions: One of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention. Key words: ART discontinuation, lost to follow-up, defaulting, retrospective cohort, prevalence, trend, and risk factors, Ethiopia