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Introduction Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed. Methods We used data from the ‘Cohort of African people Starting Antiretroviral therapy’ (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan–Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition. Results A total of 1198 patients were included in the study. Kaplan–Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count

Background HIV/AIDS represents one of the major health challenges of Ethiopia, despite a proven record of universal access to HIV care and treatment. Long-term antiretroviral therapy (ART) retention is a key factor for personal and public health benefits. Identification of determinants of attrition is needed to design appropriate interventions. Methods We used data from the CASA project, a prospective, multisite study of a cohort of HIV-infected patients who started ART in seven urban and rural health facilities located in the Tigray. We analysed the retention in care and its associated determinants in over 1000 patients followed for two years. The main outcome measure was the retention in care rate, defined as the proportion of patients alive and receiving ART at the same health facility as at ART initiation. Kaplan-Meier method was used to estimate the probability of retention at different time points. Cox Proportional Hazards model with robust sandwich estimates to account for within health facility correlation was used to identify factors associated with retention. Results Kaplan–Meier estimates of retention in care were 83.9%, 80.6% and 77.6% at 12, 18 and 24 months of follow-up, respectively. Attrition was mainly due to lost-to-follow-up and transferred-out patients. Multivariate Cox proportional hazard model showed that being male (HR 1.35, 95% CI: 1.04–1.75), CD4 count Conclusions According to our prospective data, combined interventions aimed to improve ART retention shall include expansion of HIV testing and earlier initiation of therapy, nutrition supplementation, early detection and treatment of TB. Observed retention differences among health facilities and according to gender suggest that innovative models of HIV care shall also be explored.

Introduction Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia. Methods We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation. Results The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77–3.23). Active TB (HR 1.72, 95% CI: 1.23–2.41) and gender (HR 1.64, 95% CI: 1.10–2.56) were also significantly associated with attrition. Conclusions Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific interventions should be directed to people of different sex to improve retention in care in male population.