Incidence and predictors of lost to follow up among children receiving antiretroviral therapy a computing risk regression model

Loss to follow-up (LTFU) poses a major challenge to achieving the joint United Nations Programme on HIV/AIDS 95-95-95 targets and ending the HIV epidemic by 2030. Despite government efforts, high LTFU rates in the test-and-treat era underscore the need for updated strategies. This study aimed to identify incidence and predictors of lost to follow-up among children receiving antiretroviral therapy (ART) in Amhara region. A multicenter facility-based retrospective follow-up study was conducted on 486 children receiving ART in Amhara Region Comprehensive Specialized Hospitals from August, 2014, to March, 2023. A systematic random sampling technique was used to select the study participants. Data were collected using national antiretroviral intake and follow-up forms through the KoBo Toolbox. Data analysis was done using STATA version 17. Descriptive analyses were summarized using the tables, and figures were used to present. Both bivariable and multivariable competing regression model were fitted to identify predictors of LTFU. Finally, adjusted sub-hazard ratio with 95% Confidence Interval (CI) was computed, and variables having a p-value < 0.05 were considered as statistically significant predictors of LTFU. Among 455 (93.62%) patient charts were included in the final analysis, 13.19% and 6.81% of the individuals LTFU and death within the follow-up period respectively. In this study, the overall incidence of LTFU was found to be 3.67 per 100 child-year observations (95% (CI): 2.85, 4.73). HIV-infected children age less than five years [adjusted sub-hazard ratio (aSHR): 2.95 (95% CI: 1.34, 6.49)], rural residence [aSHR: 3.39 (95% CI: 2.02, 5.73)], no regimen change [aSHR: 1.98 (95% CI: 1.16, 3.38)], and ART side effect [aSHR: 1.92 (95% CI: 1.13, 3.24)] were predictors for LTFU. The incidence of LTFU among HIV-infected children remains high, with younger age, rural residence, regimen changes, and ART side effects identified as key predictors. Strengthening counseling services, monitoring and managing ART side effects, and implementing an ART outcome evaluation program could help reduce LTFU.