Incidence and predictors of attrition among children on anti-retroviral therapy at Gedeo zone selected public hospitals, SNNPR, 2020
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Date
2020-09
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
Background: Human immune deficiency virus (HIV) is one of the world‟s most serious
public health challenges. However, the expanded access to antiretroviral therapy has led to an
intense reduction in HIV related morbidity and mortality among children. Despite this
remarkable achievement, the attrition of children from ART care has remain challenging.
Objective of the study: To assess the incidence and predictors of attrition among children on
antiretroviral therapy in Gedeo zone public hospitals, Southern Ethiopia, 2020.
Method: Retrospective follows up study was employed among 254 systematicaly selected
children <15 years who were receiving ART in Gedeo zone public hospitals. The total sample
size was calculated using Epi Info version 7. Data were collected using data extraction tool.
Data were cleaned and edited before analysis and then entered into epidata manager version
4.6 and exported to Stata version 14 for analysis. Data were described using Kaplan-Meier
curve, log rank test, life table and crude hazard ratios. Predictors of attrition assessed using
Cox proportional hazards model. Covariates with p-values (<0.25) in the bivariable analysis
were included to multivariate analysis. Finally, a statistical significance was declared at pvalue
<0.05.
Data
were
presented
using
tables,
figures,
and
texts.
Results:
The
incidence
rate
of
attrition
was
11.3
per1000
person-months
observation
(95%CI:
9.20
-13.85)
with
a
total
of
8145.33
child-months
observation.
The
median
survival
time
was
68.73
months.
Children
with
low
hemoglobin
levels
(AHR
=
3.5,
95%
CI:1.6-7.4),
low
CD4
count
(AHR=3.7, 95%CI:1.4- 9.7), delayed developmental stage (AHR=3.76, 95%CI:1.211),
underweight
(AHR=5,
95%CI:1.5-17.25)
and
poor/fair
ART
adherence
levels
(AHR=3.2,
95%
CI:1.3-7.8)
were
at
higher
hazards
of
experiencing
attrition.
Conclusion
and
recommendation:
The
incidence
rate
of
attrition
was
11.3
per1000
personmonths
observation.
Low
Hgb
level
(Hgb<10mg/dl),
low
CD4+count,
underweight
(WFAz
<
-2),
delayed
developmental
stage
and
poor/fair
ART
adherence
level
were
predictors
of
child
attrition.
So, early detection, close follow up, monitoring and management has to be
strengthened particularly for patients with low CD4+ count, underweight and low
haemoglobin level to reduce attrition from ART care. Improving adherence counseling and
strengthen nurtritional support also crucial.
Description
Keywords
ART, Children, HIV/ADIS, Attrition, Incidence, Ethiopia