Proportion of Attrition and Associated Factors Among Children Receiving Antiretroviral Therapy in Public Health Facilities, Southern Ethiopia

Figures & data

Figure 1 A flow chart of recruitment among children receiving ART in Gamo and South Omo Zones public health facilities, Southern Ethiopia, 2022.

Table 1 Socio-Demographic Characteristics of Children Receiving ART at Public Health Facilities of Gamo and South Omo Zones, Southern Ethiopia, 2022 (N=330)

Variables	Categories	Frequency (%)	Proportion of Attrition (%)
Age (years)	≤3 years	120 (36.36)	46 (13.94)
	4–8 years	117 (35.45)	34 (10.30)
	≥9 years	93 (28.18)	27 (8.18)
Sex	Male	157 (47.58)	50 (15.15)
	Female	173 (52.42)	57 (17.27)
Residence	Urban	168 (50.91)	49 (14.85)
	Rural	162 (49.09)	58 (17.58)
Parent status	Both alive	144 (43.64)	34 (10.30)
	Either died	139 (42.12)	58 (17.58)
	Both died	47 (14.24)	15 (4.55)
Caregiver-child relationship	Biological family	280 (84.85)	89 (26.97)
	Others^a	50 (15.15)	18 (5.45)
Age of caregiver	≤24 years	12 (3.64)	2 (0.61)
	25–34 years	115 (34.85)	35 (10.61)
	35–44 years	138 (41.82)	42 (12.73)
	≥45 years	65 (19.70)	28 (8.48)
Educational status of the caregiver	No formal education	170 (51.52)	65 (19.70)
	Primary	107 (32.42)	33 (10.00)
	Secondary	25 (7.58)	2 (0.61)
	Tertiary and above	28 (8.48)	7 (2.12)
Occupational status of the caregiver	Farmer	92 (27.88)	36 (10.91)
	Merchant	51 (15.45)	16 (4.85)
	Gov’t employee	42 (12.73)	11 (3.33)
	Daily laborer	114 (34.55)	36 (10.91)
	Others^b	31 (9.39)	8 (2.42)
Mode of entry to care	Voluntary counseling and testing (VCT)	36 (10.91)	7 (2.12)
	Medical referral (linkage)	241 (73.03)	78 (23.64)
	Dried blood spots (DBS)	40 (12.12)	20 (6.06)
	Others^c	13 (3.94)	2 (0.61)

Notes: ^aOther: relative, not relative; ^bOthers: Housewife, Gospel preacher; ^cOther: without a referral, Index case testing.

Abbreviations: DBS, dried blood spot; VCT, voluntary counseling and testing.

Table 2 Clinical and Treatment-Related Characteristics of Children Receiving ART at Public Health Facilities of Gamo and South Omo Zones, Southern Ethiopia, 2022 (N=330)

Variables	Categories	Frequency (%)	Proportion of Attrition (%)
Type of health facilities	Hospital	259 (78.48)	84 (25.45)
	Health center	71 (21.52)	23 (6.97)
Test-treat	Yes	167 (50.61)	53 (16.06)
	No	163 (49.39)	54 (16.36)
BMI for age	<z-score	103 (31.21)	36 (10.91)
	≥ z-score	227 (68.79)	71 (21.52)
Weight for age (n = 281)	Underweight	95 (33.81)	34 (12.10)
	Not underweight	186 (66.19)	57 (20.28)
Height for age	Stunting	107 (32.42)	38 (11.52)
	Not stunting	223 (67.58)	69 (20.91)
Developmental milestone (n = 154)	Normal	101 (65.58)	28 (18.18)
	Delayed/regressed	53 (34.42)	28 (18.18)
Functional status (n = 176)	Working	86 (48.86)	17 (9.66)
	Ambulatory/bedridden	90 (51.14)	33 (18.75)
WHO clinical stage	I or II	213 (64.55)	55 (16.67)
	III or IV	117 (35.45)	52 (15.76)
Presence of TB	Yes	46 (13.94)	25 (7.58)
	No	284 (86.06)	82 (24.85)
Presence of OI other than TB	Yes	70 (21.21)	25 (7.58)
	No	260 (78.79)	82 (24.85)
CPT Prophylaxis	Yes	259 (78.48)	95 (28.79)
	No	71 (21.52)	12 (3.64)
INH Prophylaxis	Yes	218 (66.06)	64 (19.39)
	No	112 (33.94)	43 (13.03)
Hemoglobin level (in mg/dL)	<10 mg/dL	80 (24.24)	47 (14.24)
	≥10 mg/dL	250 (75.76)	60 (18.18)
CD4 count (in cells/mm^3)	≤200cell	71 (21.52)	44 (13.33)
	200–350ce	52 (15.76)	23 (6.97)
	≥350 cells	207 (62.73)	40 (12.12)
Regimen based	Protease Inhibitor (PI)	50 (15.15)	16 (4.85)
	Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)	259 (78.48)	89 (26.97)
	Integrase Strand Transfer Inhibitor (INSTI)	21 (6.36)	2 (0.61)
Disclosure	Yes	73 (22.12)	14 (4.24)
	No	257 (77.88)	93 (28.18)
Regimen change	Yes	168 (50.91)	27 (8.18)
	No	162 (49.09)	80 (24.24)
Adherence	Good	183 (55.45)	30 (9.09)
	Fair	48 (14.55)	20 (6.06)
	Poor	99 (30.00)	57 (17.27)

Table 3 Bivariable and Multivariable Analysis for Factors Associated with Attrition Among Children Receiving ART in Public Health Facilities of Gamo and South Omo Zones, Southern Ethiopia, 2022 (N=330)

Variables	Categories	Attrition Status		COR (95% CI)	AOR (95% CI)	P-value
		Yes	No
Age	≤3 years	46	74	1.52 (0.85, 2.71)	1.18 (0.40, 3.49)	0.76
	4–8 years	34	83	1.00 (0.55, 1.82)	0.59 (0.22, 1.60)	0.30
	≥9 years	27	66	1	1
Residence	Urban	49	119	1	1
	Rural	58	104	1.35 (0.85, 2.15)	1.32 (0.67, 2.60)	0.43
Parent status	Both alive	34	110	1	1
	Either died	58	81	2.31 (1.39, 3.86)	2.19 (1.14, 4.18)*	0.018
	Both died	15	32	1.52 (0.74, 3.13)	3.19 (1.20, 8.52)*	0.02
Age of caregiver	≤24 years	2	10	0.26 (0.05, 1.30)	0.36 (0.06, 2.22)	0.27
	25–34 years	35	80	0.58 (0.31, 1.09)	0.44 (0.18, 1.06)	0.07
	35–44 years	42	96	0.58 (0.31, 1.06)	0.57 (0.24, 1.33)	0.19
	≥45 years	28	37	1	1
Educational status of the caregiver	No formal education	65	105	1.86 (0.75, 4.61)	1.92 (0.61, 6.08)	0.27
	Primary	33	74	1.34 (0.52, 3.45)	1.85 (0.56, 6.11)	0.32
	Secondary	2	23	0.26 (0.05, 1.40)	0.18 (0.02, 1.48)	0.11
	Tertiary & above	7	21	1	1
Occupational status of the caregiver	Farmer	36	56	1.81 (0.81, 4.05)	0.61 (0.09, 4.37)	0.63
	Merchant	16	35	1.29 (0.52, 3.19)	0.48 (0.07, 3.23)	0.45
	Gov’t employee	11	31	1	1
	Daily laborer	36	78	1.30 (0.59, 2.88)	0.63 (0.10, 3.99)	0.62
	Others^a	8	23	0.98 (0.34, 2.82)	0.47 (0.06, 3.84)	0.48
Presence of TB	Yes	25	21	2.93 (1.56, 5.53)	1.41 (0.57, 3.49)	0.46
	No	82	202	1	1
Mode of entry to care	VCT	7	29	1	1
	Medical referral (linkage)	78	163	1.98 (0.83, 4.72)	0.37 (0.11, 1.30)	0.12
	DBS	20	20	4.14 (1.48, 11.63)	1.41 (0.32, 6.22)	0.65
	Others^b	2	11	0.75 (0.14, 4.20)	0.14 (0.02, 1.17)	0.07
CPT Prophylaxis	Yes	95	164	1	1
	No	12	59	0.35 (0.18, 0.69)	0.61 (0.26, 1.44)	0.26
IPT Prophylaxis	Yes	64	154	1	1
	No	43	69	1.50 (0.93, 2.42)	0.82 (0.37, 1.84)	0.63
Hemoglobin level	<10 mg/dL	47	33	4.51 (2.65, 7.67)	2.39 (1.21, 4.70)*	0.01
	≥10 mg/dL	60	190	1	1
WHO clinical stage	I & II	55	158	1	1
	III & IV	52	65	2.30 (1.43, 3.70)	1.13 (0.50, 2.55)	0.78
CD4 count	≤200 cells/mm^3	44	27	6.80 (3.77, 1 2.28)	6.78 (3.16, 14.53)*	<0.01
	200–350 cells/mm^3	23	29	3.31 (1.73, 6.32)	2.65 (1.16, 6.03)*	0.02
	≥350 cells/mm^3	40	167	1	1
Adherence	Good	30	153	1	1
	Fair/poor	77	70	5.61 (3.38, 9.32)	6.38 (3.36, 12.19)*	<0.01
Regimen change	Yes	27	141	1	1
	No	80	82	5.09 (3.05, 8.52)	6.88 (3.58, 13.19)*	<0.01
Disclosure status	Disclosed	14	59	1	1
	Not disclosed	93	164	2.39 (1.27, 4.51)	1.90 (0.84, 4.30)	0.12

Notes: ^aOthers: Housewife, Gospel preacher; ^bOthers: Without a referral, Index case testing, *Significant at P-value <0.05.

Abbreviations: AOR, adjusted odds ratio; ART, antiretroviral therapy; CD4, cluster of differentiation 4; CI, confidence interval; COR, crude odds ration; CPT, Cotrimoxazole prophylaxis therapy; DBS, dried blood spot; TB, tuberculosis; VCT, voluntary counseling and testing; WHO, world health organization.