Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia

Raffaella Bucciardini, Vincenzo Fragola, Teshome Abegaz, Stefano Lucattini, Atakilt Halifom, Eskedar Tadesse, Micheal Berhe, Katherina Pugliese, Luca Fucili, Massimiliano Di Gregorio, Marco Mirra, Paola De Castro, Roberta Terlizzi, Paola Tatarelli, Andrea Binelli, Teame Zegeye, Michela Campagnoli, Stefano Vella, Loko Abraham, Hagos Godefay

Research output: Contribution to journalArticlepeer-review


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 <200 cells/µL and the type of HF were significantly associated with attrition.

CONCLUSIONS: The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.

Original languageEnglish
Pages (from-to)e000325
JournalAnnals of Global Health
Issue number3
Publication statusPublished - 2017


  • HIV infection
  • Adults
  • Ethiopia
  • Prospective studies
  • Cohort studies


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