AUTHOR=Facha Wolde , Tadesse Takele , Wolka Eskinder , Astatkie Ayalew 

TITLE=Attrition from care and its predictors among women exposed to dolutegravir- and efavirenz-based first-line antiretroviral therapy in Ethiopia: a before-and-after study

JOURNAL=Frontiers in Public Health

VOLUME=Volume 12 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1385441

DOI=10.3389/fpubh.2024.1385441

ISSN=2296-2565

ABSTRACT=The effect of Dolutegravir (DTG)-based regimens on reducing attrition from care among women on prevention of mother-to-child transmission (PMTCT) care is unknown. Therefore, this study aimed to compare the incidence of attrition among women exposed to DTG-versus Efavirenz(EFV)-based first-line antiretroviral therapy (ART) in Ethiopia.Methods: An uncontrolled before-and-after study design was employed among 932 women (466 on EFV-based and 466 on DTG-based regimens) enrolled in PMTCT care from September 2015 to February 2023. The outcome variable was attrition (maternal death or lost to follow-up before their infants" final HIV status was determined). A Kaplan-Meier estimator was employed to estimate the probability of attrition. The Cox proportional hazards regression model was fitted to identify predictor variables. The adjusted hazard ratio (aHR) with the corresponding 95% Confidence Interval (CI) was calculated to examine the risk difference in the comparison groups.The cumulative incidence of attrition among women is 5.2% (3.0% in the DTGbased regimens and 7.3% in the EFV-based regimens). Women on DTG-based regimens had a 57% (aHR: 0.43; 95% CI: 0.23, 0.80) lesser hazard of attrition from care than women on EFV-based regimens. Women who delivered their infants at home (aHR: 2.35; 95% CI: 1.14, 4.85), had poor/fair adherence (aHR: 3.23; 95% CI: 1.62, 6.45), had unsuppressed/unknown viral load status (aHR: 2.61; 95% CI: 1.42, 4.79), and did not disclose their status to partners (aHR: 2.56; 95% CI: 1.34, 4.92) had a higher hazard of attrition from PMTCT care than their counterparts.The cumulative incidence of attrition among women on PMTCT care is optimal.Besides, the risk of attrition among women on DTG-based regimens is lower than that on EFV-based regimens. Thus, DTG-based first-line ART regimen supplementation should be sustained to achieve a national retention target of 95% and above.