Time to Attrition and Associated Factors among Adults Enrolled In Pre-Anti- Retroviral Therapy Care in Tepi General Hospital, Ethiopia

Background: Pre-antiretroviral therapy (Pre-ART) patient attrition is a growing concern in Ethiopia. Nevertheless, there is little information that assesses the magnitude and its contributing factors. Objective: This study assessed time to attrition and associated factors among adults enrolled in pre-ART care at Tepi General Hospital in South West Ethiopia. Methods: Records of adult pre-ART patients enrolled at Tepi General Hospital from October 2010 to September 2013 were reviewed to identify factors associated with time to attrition. Time to attrition was defined as the period a patient was enrolled in pre-ART care until lost to follow up or death. Kaplan Meir curve was used to estimate survival time, and log-rank test was used to compare the time to event among different groups of patients. Cox proportional hazard model was used to assess factors associated with time to attrition. Results: We followed 652 pre-ART patients for 337.6 person years of observation from enrolment to pre-ART outcomes. Of these, 179 patients were lost to follow up and 37 patients died, contributing to an overall attrition of 33.13%.In the first six months the attrition rate was 89.8%. Not starting cotrimoxazole prophylaxis (AHR=1.51, 95% CI, 1.02-2.25), being co-infected with tuberculosis(TB) (AHR=2.16, 95% CI, 1.35-3.45), living further than 10 km away from the hospital (AHR=1.44, 95% CI, 1.07-2.0), and undisclosed HIV status (AHR=3.04)were found to be associated with time to attrition. Conclusion: Pre-ART patient attrition rate was high among patients not using cotrimoxazole prophylaxis, TB/HIV co-infected, living >10 km from a health care facility and with undisclosed HIV status. Close follow-up of patients during the first six months’ period is highly recommended.