Abstract:
Background: Lower Retention in antiretroviral therapy (ART) programs is one of the major
challenges in all settings and across populations. Different studies have shown that after
universal ‘test and treat’ (UTT) policy implementation retention at 6 month and 12 month was
seen to be lower in the same day initiated group when compared with those initiated on ART
after a week. Different socio-economical and clinical factors may affect patient retention from
ART care.
Objective: This study aimed to assess the long-term retention outcomes and factors associated
with attrition among people living with HIV/AIDS after UTT policy in Addis Ababa, Ethiopia
Methods: An institution-based retrospective cohort study was conducted among 334 adults
receiving antiretroviral therapy at 2 centers in Addis Ababa, Ethiopia. Study period was from
December 2022 to March 2023. The data were collected using data collection tool and cleaned
and entered into Epi info version 7.2.2 and exported to SPSS 20 for further analysis. Survival
analysis with Kaplan Meier curve, log rank test and Cox Proportional hazard models were used
to analyze the data.
Results: In this study the overall retention in care at 2 years was found to be 76.6% (73.4% in
same day initiated group and 86% in greater than 1 day initiated group). The total time observed
was found to be 554.26 person-years with the incidence rate of attrition of 14/100 PY. The
predictors of attrition based on this study were found to be being male [AHR: 2.31: CI
(1.276,4.184)], widowed marital status [AHR: 4.810: CI (1.488,15.552)], ambulatory or
bedridden baseline functional status [AHR: 7.645: CI (2.695, 21.688)], presence of opportunistic
infections at diagnosis [AHR: 6.251: CI (1.096, 35.638)] and same day ART initiated groups
[AHR: 2.158: CI (1.054,4.416)] and unsuppressed or not having VL at 6 month [AHR: 7.503: CI
(2.740,20.549)], at 12 months [AHR: 3.187: CI (1.321,7.686)] and at 24 months [AHR: 120.826:
CI (15.699, 931.707)]
Conclusion & recommendation: According to this study the overall long term retention in ART
care is low. The predictors of attrition were male gender, widowed marital status, ambulatory or
bedridden baseline functional status, presence of opportunistic infections at diagnosis, same day
ART initiation and unsuppressed or not having of HIV viral load. Identifying the causes of this
predictors and addressing them can contribute to enhancing the overall retention and well-being
of the patients’