Incidence of lost to follow up among HIV-positive children on antiretroviral therapy in Ethiopia: Systematic review and meta-analysis

Abstract

Background: At the end of 2022, globally, only 46% of children (aged 0-14 years) on ART had suppressed viral loads. Viral load suppression is crucial to reduce HIV-related deaths. To suppress the viral load at the expected level, children must be retained in ART treatment. Nevertheless, lost to follow-up from ART treatment continues to be a global challenge, particularly, in developing countries. Previously, primary studies were conducted in Ethiopia to assess the incidence of lost to follow-up among HIV-positive children on ART treatment. However, variations have been seen among the studies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence of lost to follow-up among HIV-positive children on ART and identify its associated factors in Ethiopia.

Methods: We searched PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online to obtain articles published up to November 20, 2023. Critical appraisal was done using the Joanna Briggs Institute checklist. Heterogeneity was identified using I-square statistics. Funnel plot and Egger's tests were used to identify publication bias. Data was presented using forest plots and tables. Random and fixed-effect models were used to compute the pooled estimate.

Results: Twenty-four studies were included in the final analysis. The pooled incidence of lost to follow-up among HIV-positive children on ART was 2.79 (95% CI: 1.99, 3.91) per 100-child-year observations. Advanced HIV disease (HR: 2.20, 95% CI: 1.71, 2.73), having opportunistic infection (HR: 2.59, 95% CI: 1.39; 4.78), fair or poor ART treatment adherence (HR: 2.92, 95% CI: 1.31; 6.54) and children aged between 1-5 years (HR: 2.1,95% CI: 1.44; 2.95) were factors associated with lost to follow up among HIV positive children on ART.

Conclusions: The overall pooled incidence of lost to follow-up among HIV-positive children on ART is low in Ethiopia. Therefore, counseling on ART drug adherence should be strengthened. Moreover, emphasis has to be given to children with advanced HIV stage and opportunistic infection to reduce the rate of lost to follow up among HIV-positive children on ART.

Trial registration: Registered in PROSPERO with ID: CRD42024501071.

Fig 1. PRISMA flow chart describing screening protocols of studies for meta-analysis.

Fig 2. The forest plots show the incidence of lost follow-up among HIV-positive children on ART, Ethiopia, 2023.

Fig 3. Forest plot shows the subgroup analysis of the incidence of lost to follow-up among HIV-positive children on ART by study regions, Ethiopia, 2023.

Fig 4. Sensitivity analysis for the incidence of lost to follow-up among HIV-positive children on ART, Ethiopia, 2023.

Fig 5. Funnel plot showing publication bias among studies used to compute the pooled incidence of lost to follow-up among HIV-positive children on ART, Ethiopia, 2023.

Fig 6. Shows the trim fill analysis for the incidence of lost to follow-up among HIV-positive children on ART, Ethiopia, 2023.