Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

BACKGROUND: It is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless the magnitude trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence trend and risk factors for ART discontinuation among adults in Southwest Ethiopia. METHODS: 12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data we applied multiple imputations assuming missing at random pattern. RESULTS: In total 4900 adult patients enrolled on ART of whom 1090 (22.3%) had discontinued 954 (19.5%) had transferred out 300 (6.1%) had died 2517 (51.4%) were alive and on ART and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak accounting for a magnitude of 10% in 2004 and 2005. Being a female (AOR = 2.1 95%CI: 1.7-2.8) having an immunological failure (AOR = 2.3 1.9-8.2) having tuberculosis/HIV co-infection (AOR = 1.5 1.1-2.1) and no previous history of HIV testing (AOR = 1.8 1.4-2.9) were the risk factors for ART discontinuation. CONCLUSIONS: One out of five adults had discontinued from ART and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females tuberculosis/HIV co-infected with immunological failure and no history of HIV testing. Therefore it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.