Influence of Lost to Follow Up from Antiretroviral Therapy Among Retroviral Infected Patients at Tuberculosis Centers in Public Hospitals of Benishangul-Gumuz, Ethiopia

Figures & data

Figure 1 Map of Benishangul Gumuz Area in the western part of Ethiopia. The present study is conducted at two Benishangul Gumuz Area hospitals. It is located in the western part of Ethiopia between 34 ° 10 ‘N and 37 ° 40ʹ E; and 09 ° 17 ‘N & 12 ° 06ʹ N. In latitude. Based on the 2007 census, the total population of the district is 670,847. About 85.4% of the national population is rural, while the remaining 14.6% is metropolitan. Adapted from Benishangul-Gumuz Region [Internet]. Benishangul-Gumuz Region; 2021. Available from: https://en.wikipedia.org/wiki/Benishangul- Gumuz_Region. Accessed Jan 13, 2021.¹²

Table 1 Sociodemographic Characteristics of Antiretroviral Therapy Patients in Tuberculosis Centers in Public Hospitals of Benishangul-Gumuz, Ethiopia (January 1, 2016 to December 31, 2018) (n=757)

Variables	Total, n (%)	In Care, n (%)	Lost to Follow Up, n (%)	p-value
Gender
Male	310 (44.5)	213 (37.5)	97 (51.3)	0.001
Female	447 (56.1)	355 (62.5)	92 (49.7)
Age group
15–24	58 (7.7)	31 (5.5)	27 (14.3)	0.001
25–34	290 (38.6)	225 (39.5)	65 (34.4)
35–44	257 (33.7)	195 (34.5)	58 (30.7)
+45	150 (20)	119 (19.5)	39 (20.6)
Marital status
Single	126 (16.6)	79 (13.9)	47 (24.9)	<0.001
Married	396 (52.3)	323 (59.6)	73 (38.6)
Divorced	121 (16)	91 (16)	30 (15.9)
Separated	52 (6.9)	33 (5.8)	19 (10.1)
Widowed/er	62 (8.2)	42 (7.4)	20 (10.6)
Education
HNFE	198 (26.2)	157 (26.6)	47 (24.9)	0.012
Grade 1–4	58 (7.7)	47 (8.3)	11 (5.8)
Grade 5–8	250 (33)	194 (34.2)	56 (29.6)
Grade 9–12	187 (24.7)	123 (21.7)	64 (33.9)
College & above	64 (8.5)	53 (9.3)	11 (5.8)
Religion
Orthodox	679 (88.6)	509 (89.6)	162 (85.7)	0.001
Muslim	73 (9.6)	51 (9)	22 (11.6)
Catholic	5 (0.7)	1 (0.2)	4 (2.1)
Others	8 (1.1)	7 (1.2)	1 (0.5)
Residence
Urban	616 (81.4)	467 (82.2)	149 (78.8)	0.301
Rural	141 (18.6)	101 (17.8)	40 (21.2)
Distance from antiretroviral therapy clinic
Around the catchment area	541 (71.5)	396 (69.7)	145 (76.7)	0.065
Not around the catchment	216 (28.5)	172 (30.3)	44 (23.3)
Employment status
Civil servant	208 (27.5)	117 (20.6)	91 (48.1)	<0.001
Self employed	342 (45.2)	300 (52.8)	42 (22.2)
Unemployed	207 (27.3)	151 (26.6)	56 (29.6)
Availability of emergency contact person
Yes	713 (94.2)	546 (96.1)	167 (88.4)	<0.001
No	44 (5.8)	22 (3.9)	22 (11.6)
Parents HIV status
Known	619 (81.8)	503 (88.6)	116 (61.4)	<0.001
Unknown	138 (18.2)	65 (11.4)	73 (38.6)
Commitment of parents
Committed	633 (83.6)	510 (89.8)	123 (65.1)	<0.001
Not committed	124 (16.4)	68 (10.2)	66 (34.9)
Personal habit
Alcohol	246 (32.6)	200 (35.2)	119 (63.0)	<0.001
Smoking	61 (8.1)	128 (22.7)	5 (2.7)
Others	133 (17.6)	41 (7.2)	20 (10.6)
None	319 (42.3)	199 (35)	47 (24.9)
Patient’s Present status
Working	601 (79.5)	480 (84.5)	121 (64.0)	<0.001
Ambulatory	128 (16.9)	78 (13.7)	50 (26.5)
Bedridden	27 (3.6)	10 (1.8)	17 (9.0)
Have child
Yes	436 (57.7)	358 (63)	78 (41.3)	<0.001
No	320 (42.3)	210 (37)	110 (58.2)
Pregnant in enrollment
Yes	131 (17.3)	123 (21.7)	8 (4.2)	<0.001
No	625 (82.7)	445 (78.1)	180 (95.2)

Table 2 Clinical Characteristics of Antiretroviral Therapy Patients in Tuberculosis Centers in Public Hospitals of Benishangul-Gumuz, Ethiopia (January 1, 2016 to December 31, 2018) (n=757)

Variables	Total, n (%)	In Care, n (%)	Lost to Follow Up, n (%)	P-value
Referral information
Within the hospital	456 (60.3)	310 (54.6)	146 (77.7)	<0.001
Outside the hospital	300 (39.7)	258 (45.4)	42 (22.3)
Disclosure of HIV status
To spouse/family members only	607 (80.3)	449 (79)	158 (84)	<0.001
To relatives/friends only	39 (6.9)	17 (9)	56 (7.4)
To all	63 (11)	3 (1.6)	66 (8.7)
To no one	27 (3.6)	17 (3)	10 (5.3)
CD4 count (cell/μL)
≤ 200 cells/mL	184 (24.4)	99 (17.5)	85 (45.2)	<0.001
201–250 cells/mL	130 (17.3)	98 (17.2)	32 (17)
251–300 cells/mL	216 (28.6)	188 (33.2)	28 (14.9)
301–350 cells/mL	133 (17.6)	112 (19.8)	21 (11.2)
> 351 cells/mL	92 (12.3)	70 (12.2)	22 (11.7)
WHO stage
Stage I	423 (56)	401 (70.7)	22 (11.7)	<0.001
Stage II	152 (20.1)	99 (17.5)	53 (28.2)
Stage III	119 (15.8)	50 (8.8)	69 (36.7)
Stage IV	61 (8.1)	17 (3)	44 (23.4)
History of tuberculosis treatment
Yes	62 (8.2)	40 (8.1)	22 (11.7)	0.044
No	693 (91.8)	527 (92.9)	166 (88.3)
Next appointment recorded
Yes	709 (93.9)	550 (97)	159 (84.6)	<0.001
No	46 (6.1)	29 (3)	17 (15.4)
INH prophylaxis
Yes	464 (61.5)	427 (75.3)	37 (19.7)	<0.001
No	191 (38.5)	140 (27.4)	151 (83.3)
Antiretroviral therapy eligibility
Clinical only	131 (17.4)	79 (13.9)	32 (27.7)	<0.001
CD4 only	262 (34.7)	165 (29.1)	67 (51.6)
Simply eligible	362 (47.9)	323 (57)	32 (20.7)
Presence of side effect
Yes	166 (22)	117 (20.6)	49 (26.1)	0.119
No	589 (78)	450 (79.4)	139 (73.9)
Initial regimen change
Yes	285 (37.7)	201 (35.4)	84 (44.7)	0.083
No	471 (62.3)	367 (64.4)	104 (55.3)
Reason for regimen change
Side effect	381 (71.8)	309 (83.1)	72 (45.3)	<0.001
Tuberculosis treatment	54 (10.2)	32 (8.6)	22 (13.8)
Treatment failure	96 (18.1)	31 (8.3)	65 (40.9)
Opportunistic infection
Yes	356 (47.3)	282 (49.8)	74 (39.8)	0.017
No	396 (52.7)	284 (50.2)	112 (60.2)
Duration on treatment
≤ 6 months	123 (16.3)	92 (16.2)	31 (16.5)	<0.001
7–12 months	99 (13.1)	41 (7.2)	58 (30.9)
13–24 months	132 (17.5)	86 (15.1)	46 (24.5)
25–36 months	89 (11.8)	49 (8.6)	40 (21.2)
37–48 months	314 (41.4)	300 (52.9)	14 (7)

Table 3 Association of Socio-Demographic Characteristics of Patients with LT Lost to Follow Up FU from Antiretroviral Therapy in Tuberculosis Centers in Public Hospitals of Benishangul-Gumuz, Ethiopia (January 1, 2016 to December 31, 2018) (n=757)

Variables	Lost to Follow Up		COR, 95% CI	p-value					AOR, 95% CI
	Controls	Cases
Gender
Male	213 (37.5)	97 (51.3)	1.757 (1.3, 2.45)	0.020					1.68 (1.085, 2.609)
Female	355 (62.5)	92 (49.7)	1	1
Age group
15–24	31 (5.5)	27 (14.3)	2.5 (1.32, 4.7)	0.003					3.3 (1.5, 7.4)
25–34	225 (39.5)	65 (34.4)	0.8 (0.5, 1.3)	0.193					1.5 (0.8, 2.6)
35–44	195 (34.5)	58 (30.7)	0.85 (0.5, 1.4)	0.474					1.2 (0.7, 2.2)
+45	119 (19.5)	39 (20.6)	1	1
Marital status
Single	79 (13.9)	47 (24.9)	1.249 (0.657, 2.377)	0.848					1.081 (0.487, 2.40)
Married	323 (59.6)	73 (38.6)	0.475 (0.263, 0.856)	0.304					0.685 (0.33, 1.40)
Divorced	91 (16)	30 (15.9)	0.692 (0.353, 1.358)	0.292					0.654 (0.296, 1.44)
Separated	33 (5.8)	19 (10.1)	1.209 (0.556, 2.627)	0.874					1.079 (0.421, 2.76)
Widowed/er	42 (7.4)	20 (10.6)	1	1
Education
HNFE	157 (26.6)	47 (24.9)	1.5 (0.725, 3.103)	0.018					3 (1.20, 7.3)
Grade 1–4	47 (8.3)	11 (5.8)	1.128 (0.448, 2.839)	0.280					1.9 (0.6, 5.7)
Grade 5–8	194 (34.2)	56 (29.6)	1.391 (0.681, 2.841)	0.075					2.2 (0.9, 5.2)
Grade 9–12	123 (21.7)	64 (33.9)	2.507 (1.225, 5.131)	0.009					3.1 (1.3, 7.4)
College & above	53 (9.3)	11 (5.8)	1	1
Recent distance from antiretroviral therapy clinic
Around the catchment	395 (69.5%)	142 (75.1%)	1.431 (0.977, 2.097)	0.9					1.05 (0.66, 1.7)
Not around catchment	173 (30.5%	47 (24.9%)	1	1
Employment status
Civil servant	117 (20.6)	91 (48.1)	2.097 (1.39, 3.164)	0.004					2 (1.3, 3.54)
Self employed	300 (52.8)	42 (22.2)	0.378 (0.242, 0.589)	0.457					0.817 (0.48, 1.39)
Unemployed	151 (26.6)	56 (29.6)	1	1
Availability of emergency contact person
Yes	546 (96.1)	167 (88.4)	0.306 (0.165, 0.566)	0.003					0.73 (0.33, 1.6)
No	22 (3.9)	22 (11.6)	1	1
Parents HIV status
Known	503 (88.6)	116 (61.4)	0.205 (0.139, 0.303)	0.049					0.5 (0.24, 0.997)
Unknown	65 (11.4)	73 (38.6)	1	1
Parents Commitment
Committed	510 (89.8)	123 (65.1)	0.212 (0.142, 0.317)	0.185					0.6 (0.286, 1.3)
Not committed	68 (10.2)	66 (34.9)	1	1
Personal habit
Alcohol	199 (35)	47 (24.9)	6.04 (2.342, 15.6)	0.001					8.4 (3.14, 22.4)
Smoking	200 (35.2)	119 (63.0)	12.5 (4.409, 35.4)	0.003					4.5 (1.7, 12.3)
Others	128 (22.7)	5 (2.7)	14.85 (5.9, 37.3)	0.001					6.3 (2.03, 19.4)
None	41 (7.2)	20 (10.6)	1	1
Patient functional status
Working	480 (84.5)	121 (64.0)	0.148 (0.066, 0.332)	0.001					0.16 (0.06, 0.4)
Ambulatory	78 (13.7)	50 (26.5)	0.38 (0.16, 0.889)	0.06					0.4 (0.14, 0.82)
Bedridden	10 (1.8)	17 (9.0)	1	1

Table 4 Association of Clinical Characteristics of Patients with Lost to Follow Up from Antiretroviral Therapy in Tuberculosis Centers in Public Hospitals of Benishangul-Gumuz, Ethiopia (January 1, 2016 to December 31, 2018) (n=757)

Variables	Lost to Follow Up		COR, 95% CI	p-value AOR, 95% CI
	Controls	Cases
Disclosure of HIV status
To spouse/family members only	449 (79)	158 (84)	0.598 (0.268, 1.334)	0.240.31 (0.044, 2.16)
To relatives/friends only	17 (9)	56 (7.4)	0.741 (0.282, 1.948)	0.350.35 (0.04, 3.14)
To all	3 (1.6)	66 (8.7)	0.081 (0.020, 0.327)	0.0010.004 (0.001, 0.09)
To no one	17 (3)	10 (5.3)	1	1
WHO stage
Stage I	401 (70.7)	22 (11.7)	0.021 (0.01, 0.043)	0.0010.03 (0.007, 0.09)
Stage II	99 (17.5)	53 (28.2)	0.207 (0.108, 0.4)	0.0170.3 (0.067, 0.769)
Stage III	50 (8.8)	69 (36.7)	0.533 (0.3, 1.04)	0.335.54 (0.169, 1.8)
Stage IV	17 (3)	44 (23.4)	1	1
Next appointment recorded
Yes	550 (97)	159 (84.6)	0.169 (0.09, 0.316)	0.0040.2 (0.06, 0.6)
No	29 (3)	17 (15.4)	1	1
INH prophylaxis
Yes	427 (75.3)	37 (19.7)	0.08 (0.053, 0.12)	0.0010.05 (0.023, 0.114)
No	140 (27.4)	151 (83.3)	1	1
Initial regimen change
Yes	201 (35.4)	84 (44.7)	1.475 (1.055, 2.062)	0.00633 (14.6, 72.3)
No	367 (64.4)	104 (55.3)	1	1
Reason for regimen change
Side effect	309 (83.1)	72 (45.3)	0.11 (0.067, 0.183)	0.0018 (3, 21.5)
Tuberculosis treatment	32 (8.6)	22 (13.8)	0.33 (0.164, 0.654)	0.033 (1.8, 8.8)
Treatment failure	31 (8.3)	65 (40.9)	1	1

Benishangul-Gumuz Region [Internet]. Benishangul-Gumuz Region; 2021. Available from: https://en.wikipedia.org/wiki/Benishangul-Gumuz_Region. Accessed Jan 13, 2021.

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