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Meta-Analysis
. 2020 Jun 22;20(1):439.
doi: 10.1186/s12879-020-05168-3.

HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis

Nurilign Abebe Moges  1   2 , Adesina Olubukola  3 , Okunlola Micheal  3 , Yemane Berhane  4
Affiliations
Meta-Analysis

HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis

Nurilign Abebe Moges et al. BMC Infect Dis. .

Abstract

Background: There is paucity of evidence on the magnitude of HIV patients' retention and attrition in Ethiopia. Hence, the aim of this study was to determine the pooled magnitude of HIV patient clinical retention and attrition and to identify factors associated with retention and attrition in Ethiopia.

Methods: Systematic review and meta-analysis were done among studies conducted in Ethiopia using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies conducted from January 1, 2005 to June 6th, 2019 were included. Major databases and search engines such as Google Scholar, PUBMED, African Journals Online (AJOL) and unpublished sources were searched to retrieve relevant articles. Data were assessed for quality, heterogeneity and publication bias. Analysis was conducted using STATA version 14 software.

Result: From a total of 45 studies 546,250 study participants were included in this review. The pooled magnitude of retention in care among HIV patients was 70.65% (95% CI, 68.19, 73.11). The overall magnitude of loss to follow up 15.17% (95% CI, 11.86, 18.47), transfer out 11.17% (95% CI, 7.12, 15.21) and death rate were 6.75% (95% CI, 6.22, 7.27). Major determinants of attrition were being unmarried patient (OR 1.52, 95% CI: 1.15-2.01), non-disclosed HIV status (OR 6.36, 95% CI: 3.58-11.29), poor drug adherence (OR 6.60, 95% CI: 1.41-30.97), poor functional status (OR 2.11, 95% CI: 1.33-3.34), being underweight (OR 2.21, 95% CI: 1.45-3.39) and advanced clinical stage (OR 1.85, 95% CI: 1.36-2.51). Whereas absence of opportunistic infections (OR 0.52, 95% CI: 0.30-0.9), normal hemoglobin status (OR 0.29, 95% CI: 0.20-0.42) and non-substance use (OR 95% CI: 0.41, 0.17-0.98) were facilitators of HIV patient retention in clinical care.

Conclusion: The level of retention to the care among HIV patients was low in Ethiopia. Socio-economic, clinical, nutritional and behavioral, intervention is necessary to achieve adequate patient retention in clinical care.

Keywords: Attrition; Ethiopia; HIV patient; Retention; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Studies included in systematic review and meta-analysis of HIV patients attrition and its determinants in Ethiopia
Fig. 2
Fig. 2
Magnitude of HIV patients retention of care in Ethiopia from 2005 to 2019
Fig. 3
Fig. 3
Magnitude of HIV patients’ retention by years of follow up in Ethiopia from 2005 to 2019
Fig. 4
Fig. 4
Magnitude of loss to follow up of HIV patients in Ethiopia from 2005 to 2019
Fig. 5
Fig. 5
Incidence rate of loss to follow up among HIV patient on treatment in Ethiopia
Fig. 6
Fig. 6
Magnitude of HIV patient mortality in Ethiopia from 2005 to 2019
Fig. 7
Fig. 7
Magnitude of transfer out of HIV patients in Ethiopia from 2005 to 2019
See this image and copyright information in PMC

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