Retention of patients in HIV/AIDS care at the healthcare facility level in Ethiopia: Same-day antiretroviral initiation status

Retention of patients in HIV/AIDS care at the healthcare facility level in Ethiopia: Same-day antiretroviral initiation status | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Retention of patients in HIV/AIDS care at the healthcare facility level in Ethiopia: Same-day antiretroviral initiation status Kidanu Hurisa Chachu, KEFILOE ADOLPHINA Maboe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4291094/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To meet the ambitious goal of eradicating the HIV epidemic by 2030, the Joint United Nations Programme on HIV/AIDS has set 95-95-95 targets. These targets aim for 95% of HIV-infected individuals to know their status, 95% to initiate antiretroviral therapy (ART), and 95% to achieve virologic suppression by 2030. In Ethiopia, progress towards these targets has been made, but challenges persist. This study aims to evaluate same-day ART initiation status regarding retention of patients in HIV/AIDS care at the healthcare facility level in Ethiopia. Methods A cross-sectional study design was conducted involving retrospective document analysis of 332 clinical records. The study included clinical records of patients initiated on same-day ART from the 1st of October 2017 until the 30th of October 2019. Data was analyzed quantitatively, descriptive and inferential statistical analyses were performed using Statistical Package for Social Science (SPSS) version 28.0 software. Data analysis involved conducting logistic regression to examine the relationships between factors associated with retention in HIV care. Results The results indicated varying retention rates over different time intervals: 35% at 6 months (n = 49), 81% at 12 months (n = 50), 89% from 13 to 18 months (n = 63), and 94% at 24 months (n = 34), with an overall retention in HIV/Care at 59% (n = 196). The study’s logistic regression analysis revealed that gender has a significant effect on retention (β = 2.890, p < 0.01), tertiary education was 0.2 times greater than no formal education, that is, (β = 0.212, p < 0.05), tertiary education was 0.13 times more than a secondary education, which is (β = 0.131, p < 0.01), patients who reside in urban areas were more likely to be retained than those who reside in rural areas, that is, (β = 0.467, p < 0.05), patients with a good level of adherence were 0.1 times more likely to be retained in comparison to those with a fair level of adherence (β = 0.092, p < 0.01). Conclusion The study underscores the importance of same-day ART initiation in enhancing retention rates among patients in HIV/AIDS care in Ethiopia. Factors such as gender, education level, urban residence, adherence, functional status, and WHO stage significantly influence retention. Addressing these factors through targeted interventions is crucial for achieving sustained improvements in HIV care and advancing towards epidemic eradication goals by 2030. Clinical records HIV lost to follow-up retention same-day ART initiation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction The first evidence of the human immunodeficiency virus (HIV) epidemic in Ethiopia was detected in 1984 [ 1 ]. Since then, millions of Ethiopians have fallen prey to HIV/AIDS, which has also left behind hundreds of thousands of orphans. The government of Ethiopia took several steps towards preventing further disease spread and increasing accessibility to HIV prevention, care, treatment, and support for people living with HIV. The Federal Ministry of Health Ethiopia [ 1 ] reported that approximately 414,854 adults and 21,146 children below the age of 15 years took antiretroviral (ARV) drugs in Ethiopia in 2017. According to the country factsheets of the UNAIDS, the number of people receiving ART in Ethiopia was 500,000 in 2022 [ 2 ]. The consolidated guidelines of the World Health Organization (WHO) recommended the use of antiretroviral drugs for treating and preventing HIV infection and the rapid antiretroviral therapy (ART) initiation recommendation [ 3 ]. These recommendations support initiatives and measures such as early ART initiation, including same-day ART initiation regardless of WHO staging. It is against this context that Ethiopia developed consolidated national guidelines for protracted HIV prevention, care and treatment and started to implement same-day ART initiation in October 2017 [ 1 ]. According to the Federal Ministry of Health Ethiopia [ 1 ], it is critical for people living with HIV to initiate ART as early as possible, including same-day ART initiation. This will reduce the time between the diagnosis of HIV and ART initiation, thereby significantly reducing mortality and morbidity linked to HIV, as well as forward transmission of HIV, including mother-to-child transmission [ 1 ]. The HIV epidemic in Ethiopia is heterogeneous by gender, geographic area, and population group. Furthermore, HIV prevalence is seven times higher in urban areas, at 2.9% as opposed to 0.4% among both men and women in rural areas. In addition, HIV prevalence among women in urban areas is 3.6%, as opposed to 0.6% among rural women. Seven (7) out of the nine (9) regional states and two city administrations have HIV prevalence rates above 1%. Identification of HIV prevalence by region shows that it is highest in Gambella (4.8%), followed by Addis Ababa (3.4%), Dire Dawa (2.5%), and Harari (2.4%) [ 4 ]. The outcomes of some recent randomized trials have shown that rapid ART initiation, including same-day initiation, could improve program outcomes, especially by lessening loss to care in the pre-ART period [ 5 ]. However, evidence from program settings suggests that rapid ART initiation may result in optimized loss to follow-up after ART initiation due to insufficient time to accept and disclose HIV status and prepare for lifelong treatment [ 6 ]. Ethiopia is one of the Sub-Saharan African countries that has committed to reaching 90% of HIV-positive people, initiating ART for 90% of those reached, virally suppressing 90% of those on ART by 2020, and ending the HIV epidemic by 2030. To achieve the three 90’s by 2020 and end the HIV epidemic by 2030, Ethiopia is implementing same-day ART initiation and differentiated service delivery (DSD) [ 1 ]. The status of same-day ART initiation, its challenges, and benefits for retention and viral suppression remains unclear in Ethiopia. A researcher affiliated with an NGO specializing in HIV technical support for healthcare facilities in Ethiopia highlighted the challenge of lost follow-up among patients initiating same-day ART. Thus, this study aims to investigate the status of same-day ART initiation in selected healthcare facilities in Ethiopia. This study’s purpose was to evaluate same-day ART initiation status regarding retention in HIV/AIDS care at selected healthcare facilities in Ethiopia. The results of this study will assist healthcare providers, program managers, and policy designers at the federal level to understand and address factors linked with same-day ART initiation and tracing patients lost to follow-up from HIV/AIDS care in Ethiopia’s healthcare services. Methods Study setting This study, was conducted in two health care facilities in Adama and Bishoftu towns in Oromia Regional State, East Shewa zone of Ethiopia. Population The population for this study was the clinical records of patients started on ART from the 1st of October 2017 until the 30th of October 2019 in two healthcare facilities in Ethiopia. Research design A cross-sectional study design was conducted involving retrospective document analysis of 332 clinical records. Sampling and sample A probability simple random sampling technique was used in the selection of the clinical records of patients started on ART from the 1st of October 2017 until the 30th of October 2019 from selected healthcare facilities. In sample size calculation a statistician assisted and the Rao Soft formula was used to estimate the ideal sample size from each healthcare facility (Raosoft formula online [ 7 ]. The sample size for Healthcare Facility 1 was 158, and for Healthcare Facility 2, it was 174. Thus, the total sample size from both healthcare facilities was 332. The inclusion criteria encompassed the clinical records of patients who initiated ART on the same-day from the 1st of October 2017 until the 30th of October 2019. Additionally, the study included individuals belonging to adult age groups, defined as those aged 18 years and above. Data collection Data for this study was collected from the clinical records of patients started on same-day ART clinic smart care databases of selected healthcare facilities. Prior to data collection, permission was obtained from both Healthcare Facility 1 and Healthcare Facility 2. To mitigate the risk of exposure to the COVID-19 pandemic, which was classified at level 1, data collection was conducted from the smart care databases. The approved permission to access clinical records used as the consent form. The researcher, supported by data clerks, exported clinical records from the healthcare facility smart care databases for analysis. Ethical considerations The researcher received an ethical clearance certificate from the University of South Africa’s Department of Health studies (reference number: HSHDC/977/2020). Permission to conduct the study was used as a consent form to access clinical records of patients started on same-day ART from the smart care database for data collection. To maintain confidentiality and privacy, a number was assigned to clinical records instead of a patient’s name. Privacy was maintained by ensuring that the researcher had signed a confidentiality binding agreement, data collection was conducted by the researcher from the smart care database, and numbers were allocated to the clinical records. Data analysis In this study data was extracted from the smart care database, and the researcher used 332 clinical records for data analysis. A checklist was used as an instrument to capture the 332 clinical data of patients started on same-day ART. The service of the statistician was used and the collected data was entered into SPSS version 28 for data analysis. Data accuracy and quality were ensured through a thorough cleaning and preparation process conducted before data analysis. Data was checked for errors, missing values, quality, consistency, suitability, and inconsistencies, which were identified and fixed before data analysis. Validity and reliability In this study, validity was assured through the application of external, internal, content, and face validity to the data collection tool. To ensure reliability, several steps were taken. These encompassed assessing a data collection checklist for its clarity and alignment with research inquiries. Additionally, both the supervisor and statistician scrutinized the instrument's reliability during the final phase. Quantitative data was directly sourced by the researcher from the smart care database. Study Variables The study variables included gender, age, marital status, educational status, religion, patient address, patient history of opportunistic infections at enrolment, who staged at enrolment, last follow-up ARV adherence, HIV disclosure status at enrolment, last follow-up ARV adherence, and baseline BMI results. These variables were used to describe participants' health conditions, immune status, disease progression, and relevant factors that may influence ART treatment retention in care for patients started on same-day ART. Statistical analysis The collected data was entered into SPSS version 28 for data analysis. Data accuracy and quality were ensured through a thorough cleaning and preparation process conducted before data analysis. Data was checked for errors, missing values, quality, consistency, suitability, and inconsistencies, which were identified and fixed before data analysis. The data was analyzed using descriptive and inferential statistics. Descriptive statistics were employed to summarize key characteristics of the study population, including demographics, treatment initiation status, retention in HIV care, and viral suppression. With the assistance of a statistician, the researcher used frequencies and percentages to summarize the results using tables and graphs. Data analysis involved conducting logistic regression to examine the relationships between factors associated with retention in HIV care. The researcher calculated odds ratios (OR) with their 95% confidence intervals (95% CI) and considered p-values < 0.05 statistically significant. Results A total of 332 clinical records of patients’ ages above 18 who started on same-day ART were utilized for the data analysis in this study. Among these records, 91 males and 67 females totaling 158 were obtained from Healthcare Facility 1, while 69 males and 105 females totaling 174 were obtained from Healthcare Facility 2. The majority of the patients, 58.7% (n = 195), were over 35 years old; 29.5% (n = 98) were in the age range of 25–34 years; and the minority, 11.7% (n = 39), were in the range of 18–24 years. Regarding gender, the participants’ females were 52% (n = 172) and males were 48% (n = 160). Results showed that the majority, 48.5% (n = 161) of patients, were married; divorced patients were 21.7% (n = 72); those who had never been married (single) were 21.4% (n = 71); and widowed patients were 7.8% (n = 26). Figure 2 above illustrated the participant’s religion and indicated that the majority, 61.7% (n = 205) were Orthodox Christians, 18.4% (n = 61) were Protestants, 11.4% (n = 38) were Muslims, 6.6% (n = 22) were Catholic, and the minority, 1.8% (n = 6) belonged to other religious groups. From the education level perspective, the results showed that that the majority, 38.3% (n = 127) had primary education, 26.6% (n = 95) had no formal education, 25% (n = 83) had secondary education, and the minority, 8.1% (n = 27) had tertiary education. The majority, 72% (n = 239) of patients, were from urban areas, while the minority, 28% (n = 93) of patients were from rural areas and the majority, 89% (n = 294) had their phone numbers documented, 89% (n = 294), had documented kebele information. The majority, 78.6% (n = 261) of patients, had a registered house number, and the minority, 21.4% (n = 71), of patients did not. Baseline clinical and laboratory information The variables included in the in the baseline clinical and laboratory information were patients' histories of opportunistic illness, types of opportunistic infections, baseline BMI, functional status, WHO clinical staging of HIV, patients' HIV disclosure status, patients' CD4 cell count at baseline, and the actual CD4 value at baseline. The majority, 94.3% (n = 313) patients had no opportunistic infections at enrolment, while the minority, 5.7% (n = 19) of the patients had opportunistic infections at enrolment. Among OIs the majority, 68% (n = 13) of opportunistic infections were tuberculosis, 16% (n = 3), pneumocystis pneumonia (PCP), 11% (n = 2), toxoplasmosis, and the minority, 5% (n = 1) belonged to other opportunistic infections. Table 1 Frequency distribution of baseline BMI status (N = 332) BMI category Frequency (N) Percentage (%) Cumulative percent 30 kg/m 2 8 2.4 100 Total 332 100 Table 1 indicated that the majority 61.7% (n = 205) of patients had a BMI between 18.5 and 24.9 kg/m², 28.3% (n = 94), fell within the range of 25 to 29.9 kg/m², and the minority 7.5% (n = 25) had a BMI below 18.5 kg/m². Figure 3 indicated that the majority, 63.3% (n = 210), had a normal nutritional status, 7.5% (n = 25) were overweight, 6.6% (n = 22) had moderate malnutrition, 6% (n = 20) had severe malnutrition, and the minority, 2.4% (n = 8), were obese. Regarding the functional status of study participants, the majority, 90.7% (n = 301) were able to work, 6.3% (n = 21) were ambulatory (able to walk), 2.7% (n = 9) were bedridden, and the minority, 0.3% (n = 1) were not assessed for their functional status. The results showed that the majority, 63.3% (n = 210), had a normal nutritional status, 7.5% (n = 25) were overweight, 6.6% (n = 22) had moderate malnutrition, 6% (n = 20) had severe malnutrition, and the minority, 2.4% (n = 8), were obese. The participants WHO staging results showed that the majority, 54% (n = 180), belonged to WHO stage I, 26% (n = 87) were stage II, 15% (n = 51) were stage III, and the minority, 4% (n = 14), were stage IV. Figure 4 above, intimated that the majority, 53.6% (n = 178), of the patients did not inform anyone about their HIV status including their spouses or families, while the minority, 46.4% (n = 154) had disclosed their HIV status to family or friends. Regarding baseline CD4 the results showed that the majority, 65.1% (n = 216), did not have baseline CD4 results, while the minority, 34.9% (n = 116), had baseline CD4 test results. Among those who had CD4 results the majority, 29.3% (n = 34) had CD4 results < 200 cells/mm3, 26.7% (n = 31) 200–349 cells/mm3, 17.2% (n = 20) 350-499cells/mm3 and the minority, 26.7% (n = 31) ≥ 500 cells/mm3. Same-day ART initiation status related information The role of the HIV testing unit is crucial in facilitating the same-day initiation of ART. This included patients who were identified as HIV positive in other healthcare facilities and referred for ART initiation, which could sometimes cause delays in same-day ART initiation. Figure 5 showed that the majority, 27.7% (n = 92) were from the voluntary counselling and testing (VCT) unit, 24.4% (n = 69) were from the ART clinic, 19.9% (n = 66) were referred from other healthcare facilities, and the minority, 7.2% (n = 24) were linked from other service delivery points within the healthcare facility. Figure 6 below illustrates the majority of the patients, 48% (n = 160), were in HIV care for less than 6 months, 22% (n = 73) were 13–18 months, 19% (n = 63) were 6–12 months and the minority, 11% (n = 36) were 19–24 months on ART. These results indicated that a significant number of patients who started on same-day ART were lost before reaching the six-month period. The results indicated that the majority, 59% (n = 196), were in HIV care, 27% (n = 90) were lost to follow-up, 7% (n = 25) were confirmed dead, and the minority, 6% (n = 21), were transferred out to another healthcare facility. The retention status of patients started on same-day ART varies months and the results showed that that retention at 6 months was 35% (n = 49), at 12 months it was 81% (n = 50), from 13 to 18 months it was 89% (n = 63), and at 24 months it was 94% (n = 34) (Fig. 8 ). In the logistic regression analysis, a total of 311 clinical records from patients who initiated same-day ART were included, while 21 clinical records of those transferred to other healthcare facilities were omitted due to the fact that their final outcomes were not known. The logistic regression model indicated that, when adjusting for the effect of the other variables, the effect of age group on retention was not significant. The study’s logistic regression analysis revealed that gender has a significant effect on retention (β = 2.890, p < 0.01). The study results also showed that when the effect of the other variables was controlled, the odds of being retained differed significantly by level of education. The odds of being retained when a tertiary education was 0.2 times greater than no formal education, that is, (β = 0.212, p < 0.05). Similarly, the odds of being retained when a tertiary education was 0.13 times more than a secondary education, which is (β = 0.131, p < 0.01). The type of residential area also has a significant effect on retention; patients who reside in urban areas were more likely to be retained than those who reside in rural areas, that is, (β = 0.467, p < 0.05). The results also showed that adherence to ARV significantly affects retention, such that patients with a good level of adherence were 0.1 times more likely to be retained in comparison to those with a fair level of adherence (β = 0.092, p < 0.01). Similarly, patients with a good level of adherence were 0.11 times more likely to be retained in comparison with those with a poor level of adherence (β = 0.110, p < 0.05). The results of the study revealed that considering the functional status at the final follow-up, the likelihood of retention was 0.17 times greater among working functional status of patients compared to those who were ambulatory, with a coefficient (β = 0.167) and a significance level of (p < 0.05). The study results further showed that the likelihood of retention was 0.37 times higher for patients in stage I compared to stage II. Patients with WHO stage II were more likely to be retained in HIV care compared to stage I (β = 0.373, p < 0.05). Patient age, marital status, religion, the presence of opportunistic infections, and baseline BMI were not significantly related to retention in HIV care (refer to Table 2 ). Table 2 Logistic regression analysis of retention (N = 311) Variables Retention status Odds Ratio Std. Err. z P>|z| 95% Conf. Interval Retained Not retained n(%) n(%) Gender Male (ref) 78 (52.7) 70 (47.3) 1.00 0.00 Female 118 (72.4) 45 (27.6) 2.890 0.985 3.11 0.002 1.481–5.64 Age 18–24 years (ref) 22 (59.5) 15 (40.5) 1.00 0.00 25–34 years 52 (55.9) 41 (44.1) 0.400 0.241 -1.52 0.129 0.123–1.303 > 35 years 122 (67.4) 59 (32.6) 1.166 0 .692 0.26 0.260 0.364–3.735 Marital status Single (ref) 33 (52.4) 30 (47.6) 1.00 0.00 Married 103 (65.6) 54 (34.4) 1.566 0.729 0.96 0.96 0.628–3.903 Divorced 44 (63.8) 25 (36.2) 1.245 0.689 0.40 0.400 0.420–3.684 Widowed 16 (72.7) 6 (27.3) 3.386 2.717 1.52 1.520 0.702–16.323 Educational status No formal education 55 (61.8) 34 (38.2) 0.211 0.152 -2.15 0.031 0.051–0.870 Primary 79 (66.9) 39 (33.1) 0.296 0.210 -1.72 0.086 0.073–1.189 Secondary 40 (51.9) 37 (48.1) 0.130 0.094 -2.82 0.005 0.031–0.538 Tertiary (ref) 22 (81.5) 5 (18.5) 1.00 0.00 Religion Protestant 28 (50) 28 (50) 0 .518 0.215 -1.58 0.114 0..230 − 1.170 Catholic 16 (76.2) 5 (23.8) 3.149 2.051 1.76 0.078 0.878–11.293 Orthodox (ref) 132 (65.7) 69 (34.3) 1.00 0.00 Muslim 20 (60.6) 13 (39.4) 1.059 0.553 0.11 0.912 0.380–2.951 Patients address Urban (ref) 153 (67.4) 74 (32.6) 1.00 0.00 Rural 43 (51.2) 41 (48.8) 0.466 0.172 -2.06 0.039 0.226–0.962 Patient history of OI enrolment Yes (ref) 11 (61.1) 7 (38.9) 1.00 0.00 No 185 (63.1) 108 (36.9) 2.116 1.889 0.84 0.40 0.368–12.171 WHO clinical staging of HIV at enrolment Stage I (ref) 112 (66.7) 56 (33.3) 1.00 0.00 Stage II 45 (53.6) 39 (46.4) 0 .373 0.138 -2.65 0.008 0.180–0.774 Stage III 32 (68.1) 15 (31.9) 1.297 0.652 0.52 0.604 0.484–3.475 Stage IV 7 (58.3) 5 (41.7) 0 .907 1.069 -0.08 0.935 0.090–9.144 Last follow-up ARV adherence Good (ref) 122 (81.3) 28 (18.7) 1.00 0.00 Fair 74 (46) 87 (54) 0.091 0.076 -2.86 0.004 0.017–0.471 Poor 191 (68.5) 88 (31.5) 0.110 0.102 -2.38 0.018 0.017–0.679 Patient have disclosed HIV status at enrolment Yes (ref) 2 (13.3) 13 (86.7) 1.00 0.00 No 3 (17.6) 14 (82.4) 0 .155 0.054 5.27 0.000 0.077–0.310 Baseline BMI Normal (ref) 123 (63.7) 70 (36.3) 1.00 0.00 Mild/moderate malnutrition 38 (56.7) 29 (43.3) 0.717 0.275 -0.87 0.387 0.337–1.522 Severe malnutrition 12 (63.2) 7 (36.8) 1.751 1.321 0.74 0.457 0.399–7.682 Over/obese weight 23 (71.9) 9 (28.1) 0 .537 0.306 -1.09 0.276 0.175–1.643 Discussion The results showed that females had a higher prevalence of HIV infection compared to males due to their increased vulnerability in relation to males. A study which concurred with this study was conducted in South Africa on the same-day initiation of antiretroviral therapy for HIV-infected individuals, revealed that female enrolment was 74.1% (n = 9663), while males about 25.9% (n = 3375) [ 8 ]. In contrast to this study, a study was conducted in Addis Ababa, Ethiopia, on antiretroviral therapy service quality and associated factors at public hospitals revealed that a higher proportion of male patients, 67.1% (n = 282), were enrolled as compared to female patients, which was 32.9% (n = 138) [ 9 ]. Regarding the marital status, the study revealed that the majority of patients, were married and this indicated that the prevalence of HIV among married couples was high due to a lack of HIV testing prior to and during marriage. A study which concurred with this study was conducted in Ethiopia on pre-marital HIV testing among married women, revealed that only 21.4% (n = 2142) of the married couples had undergone pre-marital HIV testing [ 10 ]. In contrast with this study, a study was conducted in Eswatini, focused on the impact of same-day ART initiation under the World Health Organization's treat-all policy, found that the majority, 69.2% (n = 566) of patients on same-day ART were not married [ 11 ]. The study revealed that the majority had primary education, which revealed that HIV prevalence was high in patients who had no formal education or primary education. A study which concurred with this study was conducted in Masaka, Uganda, on factors related to loss to follow-up (LTFU) among HIV-positive patients receiving ART, revealed that patients with no formal education had a higher risk of lost to follow-up compared to those with a post-secondary education level (AHR = 0.50; 95% CI, 0.34–0.75) [ 12 ]. In contrast with this study, the study conducted in Togo on health-related quality of life among people living with HIV/AIDS, which revealed that the majority, 45.4% (n = 399), had secondary and higher education, 37% (n = 326) had primary education, and the minority, 17.6% (n = 155), had no education, which showed that the majority of patients had secondary and higher education compared to this study [ 13 ]. The study found that the majority, had their phone numbers documented. These results indicated that the majority of patients could be reached if lost through their phone number, and female patients were more likely to have a phone address and could be reachable compared to male patients. A study which concurred with this study was conducted in Kampala, Uganda, on factors associated with retention and non-viral suppression among HIV-positive patients on ART, revealed that the majority, 94.2% (n = 259) had a phone number, while the minority, 5.8% (n = 16), did not have a phone number [ 14 ]. The study showed that the majority, of patients, had a registered house number, and these results implied that the majority of patients did not have their exact location documented or house number, which played a role in home-to-home tracing for those lost from HIV care. Having a specific address is crucial in HIV prevention, care, and treatment for various reasons. A study which concurred with this study was conducted in rural Mozambique, focused on loss to follow-up and opportunities for reengagement in HIV care, found that the majority, 61.6% (n = 691) were reported lost to follow-up due to a lack of proper, specific document addresses [ 15 ]. The study showed that the majority, of opportunistic infections were tuberculosis which indicated that among patients initiated on same-day ART, tuberculosis was the most prevalent opportunistic infection, leading to co-morbidity and poor adherence due to pill burden. A study which concurred with this study was conducted in Haiti on the importance of integrated care for HIV and TB co-infection; prompt initiation of both ART and TB treatment can enhance outcomes and address the dual burden of HIV and TB. It revealed that 77.1%(n = 37) of patients who started on same-day ART had a TB infection at enrolment [ 16 ]. In contrast to this study, a study was conducted at Gondar University Comprehensive and Specialized Hospital, Ethiopia, on the incidence of opportunistic infections and its predictors among HIV/AIDS patients, revealed that the majority, 16.51% (n = 90) had pneumocystis’ pneumonia 16.33% (n = 89), had chronic diarrhea 10.82% (n = 59), had bacterial pneumonia and 10.46% (n = 57) had pulmonary tuberculosis which implied that TB was the 4th opportunistic infection [ 17 ]. Another study which differed with this study was conducted in Kinshasa, Democratic Republic of Congo, found that the majority, 45.4% (n = 54), had malaria and 29.4% (n = 35) TB which implied that TB was the 2nd opportunistic infections [ 12 ]. The study indicated that the majority belonged to WHO stage I which showed that a considerable portion of patients who began same-day ART had early-stage HIV infections with minimal symptoms, enabling them to take their medication more easily while limiting the potential for stigma and discrimination. On the other hand, patients who were ambulatory or bedridden required specialized care to facilitate medication adherence and needed additional resources or manpower to take their medication. A study which concurred with this study was conducted at Nekemte Specialized Hospital in Western Ethiopia, which focused on same-day ART initiation and its associated factors, revealed that the majority, 77.02% (n = 372) belongs to stage I, 14.08% (n = 67) were classified as stage II, and the minority, 8.91% (n = 43), of patients were classified as stages II and IV [ 18 ]. In this regard, results of this study differed with the study conducted in Malang, East Java, Indonesia, on functional status and incidence of loss to follow-up after ART initiation, which revealed that the majority, 35.8% (n = 53) were WHO stage III, 27% (n = 40) were WHO stage IV, 22.9% (n = 34) were WHO stage I, and the minority, 14.1% (n = 21), were WHO stage II, which showed the majority belongs to WHO stage III compared to this study, in which the majority belongs to WHO stage I [ 19 ]. The study showed the majority of the patients, were in HIV care for less than 6 months, which indicated that a significant number of patients who started on same-day ART were lost before reaching the six-month period. A study which concurred with this study was conducted in South African public health facilities, focusing on same-day ART initiation, reported that 33% (n = 11,114) of patients initiated on the same-day were classified as lost to follow-up, with a median time to loss of 55 days [ 20 ]. According to Joseph Davey et al [ 20 ], the results showed a retention rate of approximately 67% (n = 22,565) at six months, which aligns with the results of this study. The study indicated that the majority were lost to follow-up, and results implied that Ethiopia was significantly below the UNAIDS target of achieving 95% retention in HIV care by 2030. Furthermore, the results indicated an effort should be made to retain patients in HIV care after same-day ART initiation for the first six months. A study which was concurred with this study was conducted in South Africa on same-day ART initiation for HIV-infected adults revealed that the majority, 64.4% (n = 8399) were active in care, 29.2% (n = 3804) were lost, 6.1% (n = 793) were transferred out to other healthcare facilities and the minority,0.3% (n = 42) were died [ 8 ]. Similarly, data reported by 72 countries as a global update towards terminating AIDS progress towards the 90–90–90 targets revealed that retention on antiretroviral therapy after 12 months ranged from 72% in Western and Central Africa to 89% in the Middle East and North Africa, which concurred with this study results [ 21 ]. However, a study was conducted in Kenya at the Kibera community health center HIV/AIDS program on retention of patients in HIV care revealed that the majority, 79% (n = 67), were in care, 14% (n = 12) were lost, 6% (n = 5) were transferred to other healthcare facilities, and the minority, 1% (n = 1), were died [ 22 ]. The study showed that retention at 6 months was low which implied that retention in HIV care improved significantly after the initial six months of ART initiation. A study which concurred with this study was conducted in rural Mozambique on poor retention and care-related sex disparities among youth living with HIV, revealed that overall retention was 49% (n = 12,179) [ 23 ]. Contrary, a study that was conducted in Italy on the impact of rapid initiation of ART at HIV diagnosis on virological response in a real-life setting, indicated that the majority, 94.4% (n = 302), of patients were in HIV care at six months [ 24 ]. Two (2) provinces of the Democratic Republic of the Congo on factors associated with the retention of HIV patients on antiretroviral therapy (ART) in HIV care and revealed an overall retention rate of 78.2% (n = 38906), which was higher compared to the retention rate observed in this study [ 25 ]. Limitation of the study The study faced several limitations exacerbated by COVID-19 pandemic restrictions, notably hindering face-to-face data collection. Additionally, its retrospective nature introduces potential recall bias among patients recalling details of same-day ART initiation and follow-up events. Reliance on self-reported data may further introduce social desirability bias. Data incompleteness from the smart care database and challenges retrieving patient folders compounded the limitations. External factors like strategy changes during the study period could also influence outcomes. The cross-sectional design limited tracking longitudinal changes in patient outcomes. Furthermore, restrictions during the pandemic prevented inclusion of religious leaders and community-level associations of people living with HIV. Recognizing these limitations is crucial for informing future research and refining understanding of same-day ART initiation and associated challenges. Conclusion This study aimed to evaluate the same-day ART initiation status regarding retention of patients in HIV/AIDS. The study highlighted the significance of same-day antiretroviral therapy (ART) initiation in bolstering retention rates among HIV/AIDS patients receiving care in Ethiopia. Various factors, including gender, education level, urban residence, adherence, functional status, and WHO stage, exert notable influences on retention rates. By addressing these factors through targeted interventions, sustained enhancements in HIV care can be achieved, thus propelling progress towards the goal of eradicating the epidemic by 2030. This study results demonstrated the impact of same-day ART initiation on patient retention within Ethiopian HIV/AIDS care. With an overall retention rate of 59%, the implementation of same-day ART initiation strategies emerges as pivotal in improving patient outcomes in Ethiopia's HIV/AIDS care landscape. This study provides valuable insights into same-day ART initiation, lost to follow-up, and retention in HIV care at healthcare facilities in Ethiopia. Recommendations emphasize a holistic approach to same-day ART initiation, focusing on improved counselling, capacity building, and education. Multiple counselling sessions led by healthcare providers can address patient concerns and enhance treatment adherence through increased awareness. Declarations Ethics approval and consent to participate Ethics approval and consent to participate the study was approved by the research and Ethics Committee of the University of South Africa’s Department of Health (reference number: HSHDC/977/2020) the Oromia Regional Health Bureau and healthcare facilities where study was conducted. Consent for publication This publication does not contain any individual person’s identifying data in any form (including individual details, images or videos). Availability of data and material The data that support the results of this study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors' contributions Mr. K.H. Chachu: Conceive the study, wrote the proposal and was involved in data acquisition, data analysis, and manuscript preparation. Professor K.A. Maboe: advised during proposal development, result writing, and final manuscript preparation for publication. Both authors read and approved the final manuscript. Acknowledgements My special thanks to my supervisor, Professor K.A. Maboe, for her unwavering guidance and support throughout every stage of this thesis, from its inception to its completion. I am also profoundly thankful to the University of South Africa for affording me the opportunity to learn and for their financial support. I extend my appreciation to all members of the UNISA staff and to all those who supported me in finalizing my study in any way. References Ethiopia Ministry of Health. National Consolidated Guidelines for Comprehensive HIV prevention, Care and Treatment. 2018. UNAIDS. Ethiopian country factsheets HIV and AIDS estimates. From: https://www.unaids.org/en/regionscountries/countries/ethiopia (accessed 20 January 2024). Unaids [Internet]. 2022;1–6. Available from: https://aidsinfo.unaids.org/%0D. Organization WH. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV Infection: Recommendations for a public health approach. 2nd edition. 2016. Federal HIV/AIDS Prevention and Control Office. HIV Prevention in Ethiopia: National Road Map. 2018;(November 2018):1–43. Amanyire G, Semitala FC, Namusobya J, Katuramu R, Kampiire L, Wallenta J, et al. Effects of a multicomponent intervention to streamline initiation of antiretroviral therapy in Africa: a stepped-wedge cluster-randomised trial. Lancet HIV. 2016 Nov;3(11):e539-e548. doi: 10.1016/S2352-3018(16)30090-X. Epub 2016 Aug 27. PMID: 27658873; PM. Lancet HIV. 2016;3(11):1–23. Helova A, Akama E, Bukusi EA, Musoke P, Nalwa WZ, Odeny TA, et al. Health facility challenges to the provision of Option B+ in western Kenya: A qualitative RaoSoft.Inc. Sample size calculator. Online software. From http://www.raosoft.com/samplesize.html (accessed 10 April 2019). Sustain [Internet]. 11(1):1–14. Lilian RR, Rees K, McIntyre JA, Struthers HE, Peters RPH. Same-day antiretroviral therapy initiation for HIV-infected adults in South Africa: Analysis of routine data. PLoS One. 2020 Jan 1;15(1). Tiruneh CT, Woldeyohannes FW. Antiretroviral Therapy Service Quality and Associated Factors at Selected Public Hospitals, Addis Ababa, Ethiopia, 2021. HIV/AIDS - Res Palliat Care. 2022;14:129–42. Birhanu MY, Ketema DB, Desta M, Habtegiorgis SD, Mengist B, Alamneh AA, et al. Married women pre-marital HIV testing status in Ethiopia: Individual and community level factor analysis. Front Med. 2023;10. Kerschberger B, Boulle A, Kuwengwa R, Ciglenecki I, Schomaker M. The Impact of Same-Day Antiretroviral Therapy Initiation under the World Health Organization Treat-All Policy. Am J Epidemiol. 2021 Aug 1;190(8):1519–32. Kaseka TN, Ikolango BB, Omombo LL, Ipaya GB, Makela ND DR. Determinants of loss to follow-up among HIV positive patients receiving antiretroviral therapy in a test and treat setting: A retrospective cohort study in Masaka, Uganda. PLoS One. 2020;15(4). Yaya I, Djalogue L, Patassi AA, Landoh DE, Assindo A, Nambiema A, et al. Health-related quality of life among people living with HIV/AIDS in Togo: Individuals and contextual effects. BMC Res Notes. 2019 Mar 15;12(1). Atuhaire L, Shumba CS, Mapahla L, Nyasulu PS. A retrospective cross sectional study assessing factors associated with retention and non-viral suppression among HIV positive FSWs receiving antiretroviral therapy from primary health care facilities in Kampala, Uganda. BMC Infect Dis. 2022 Dec 1;22(1). Fuente-Soro L, López-Varela E, Augusto O, Bernardo EL, Sacoor C, Nhacolo A, et al. Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study. Med (United States). 2020;99(20). Dorvil N, Rivera VR, Riviere C, Berman R, Severe P, Bang H, et al. Same-day testing with initiation of antiretroviral therapy or tuberculosis treatment versus standard care for persons presenting with tuberculosis symptoms at HIV diagnosis: A randomized open-label trial from Haiti. PLoS Med. 2023 Jun 1;20(6). Bayisa L, Bayisa D, Turi E, Mulisa D, Tolossa T, Akuma AO, et al. Same-Day ART Initiation and Associated Factors Among People Living with HIV on Lifelong Therapy at Nekemte Specialized Hospital, Western Ethiopia. HIV/AIDS - Res Palliat Care. 2023;15:11–22. Dagnaw M, Fekadu H, Gebre Egziabher A, Yesfue T, Indracanti M, Tebeje A. Incidence of opportunistic infections and its predictors among HIV/AIDS patients on antiretroviral therapy in Gondar University Comprehensive and Specialized Hospital, Ethiopia. HIV Res Clin Pract. 2023;24(1). Dewi Ambarwati R, Eko Wardani H, Dwi Tama T. Functional Status and Incidence of Loss to Follow-up after Antiretroviral Therapy Initiation. KnE Life Sci. 2021 Mar 25. Davey DJ, Kehoe K, Serrao C, Prins M, Mkhize N, Hlophe K, et al. Same-day antiretroviral therapy is associated with increased loss to follow-up in South African public health facilities: a prospective cohort study of patients diagnosed with HIV. 2020; Available from: http://onlinelibrary.wiley.com/doi/10.1002/jia2.25529/full Progress towards the 90-90-90 targets Ending AIDS GLOBAL AIDS UPDATE | 2017. 2017. Muli-Kinagwi SK, Ndirangu M, Gachuno O, Muhula S. Retention of pediatric patients in care: A study of the kibera community health center hiv/aids program. Afr Health Sci. 2021;21:39–43. Ahonkhai AA, Aliyu MH, Audet CM, Bravo M, Simmons M, Claquin G, et al. Poor retention and care-related sex disparities among youth living with HIV in rural Mozambique. PLoS One. 2021 May 1;16(5 May). Gregori N, Renzetti S, Izzo I, Faletti G, Fumarola B, degli Antoni M, et al. Does the rapid initiation of antiretroviral therapy at HIV diagnosis impact virological response in a real-life setting? A single-centre experience in Northern Italy. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2023;35(12):1938–47. Shah GH, Etheredge GD, Nkuta LM, Waterfield KC, Ikhile O, Ditekemena J, et al. Factors Associated with Retention of HIV Patients on Antiretroviral Therapy in Care: Evidence from Outpatient Clinics in Two Provinces of the Democratic Republic of the Congo (DRC). Trop Med Infect Dis. 2022 Sep 1;7(9). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4291094","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":294105028,"identity":"4dae1edc-9d49-4a60-bca2-b3859004f979","order_by":0,"name":"Kidanu Hurisa 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(N=332)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4291094/v1/3ca10baea2c3e66e351fac43.png"},{"id":55528525,"identity":"88c2958c-4728-4a60-8be2-95137e2515ea","added_by":"auto","created_at":"2024-04-29 15:14:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":49373,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3: Baseline nutritional status participants (N=332)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4291094/v1/95a70568993451a21fd3c5bb.png"},{"id":55527752,"identity":"469db936-47e6-4f04-9799-13a6f26eccdd","added_by":"auto","created_at":"2024-04-29 15:06:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15512,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4: HIV disclosure status of patients at enrolment (N=332)\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4291094/v1/b69e45f8d13c184d6d781e2d.png"},{"id":55528523,"identity":"6db3d0cd-821a-42ec-b544-84bb971c8595","added_by":"auto","created_at":"2024-04-29 15:14:30","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":41729,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 5: HIV testing and diagnosis unit (N=332)\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4291094/v1/334490804e35c5e9117806a2.png"},{"id":55527750,"identity":"ea793190-7767-438c-a3d8-358dc8c334cc","added_by":"auto","created_at":"2024-04-29 15:06:30","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":38602,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 6: Months on ART since ART started (N=332)\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-4291094/v1/238c94eb9ab05b848f645363.png"},{"id":55527755,"identity":"5779f898-a552-4ce7-a09b-5eec2899d10d","added_by":"auto","created_at":"2024-04-29 15:06:30","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":140566,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 7: HIV care and retention status of patients (N=332)\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4291094/v1/54be4859bd459af36a0792a8.jpeg"},{"id":55527754,"identity":"b4686512-f893-4d61-b16f-475b904b0458","added_by":"auto","created_at":"2024-04-29 15:06:30","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":58831,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 8: Retention status of patients by months on ART (N=311)\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-4291094/v1/f791024cb8017d45ff3b0d8e.png"},{"id":56833790,"identity":"8a1a8a7f-5952-45f9-9421-28516c25fff8","added_by":"auto","created_at":"2024-05-21 05:17:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":960565,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4291094/v1/4bb109b7-e3fc-4159-b808-dc38862ea584.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Retention of patients in HIV/AIDS care at the healthcare facility level in Ethiopia: Same-day antiretroviral initiation status","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe first evidence of the human immunodeficiency virus (HIV) epidemic in Ethiopia was detected in 1984 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Since then, millions of Ethiopians have fallen prey to HIV/AIDS, which has also left behind hundreds of thousands of orphans. The government of Ethiopia took several steps towards preventing further disease spread and increasing accessibility to HIV prevention, care, treatment, and support for people living with HIV. The Federal Ministry of Health Ethiopia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] reported that approximately 414,854 adults and 21,146 children below the age of 15 years took antiretroviral (ARV) drugs in Ethiopia in 2017. According to the country factsheets of the UNAIDS, the number of people receiving ART in Ethiopia was 500,000 in 2022 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe consolidated guidelines of the World Health Organization (WHO) recommended the use of antiretroviral drugs for treating and preventing HIV infection and the rapid antiretroviral therapy (ART) initiation recommendation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These recommendations support initiatives and measures such as early ART initiation, including same-day ART initiation regardless of WHO staging. It is against this context that Ethiopia developed consolidated national guidelines for protracted HIV prevention, care and treatment and started to implement same-day ART initiation in October 2017 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the Federal Ministry of Health Ethiopia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], it is critical for people living with HIV to initiate ART as early as possible, including same-day ART initiation. This will reduce the time between the diagnosis of HIV and ART initiation, thereby significantly reducing mortality and morbidity linked to HIV, as well as forward transmission of HIV, including mother-to-child transmission [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe HIV epidemic in Ethiopia is heterogeneous by gender, geographic area, and population group. Furthermore, HIV prevalence is seven times higher in urban areas, at 2.9% as opposed to 0.4% among both men and women in rural areas. In addition, HIV prevalence among women in urban areas is 3.6%, as opposed to 0.6% among rural women. Seven (7) out of the nine (9) regional states and two city administrations have HIV prevalence rates above 1%. Identification of HIV prevalence by region shows that it is highest in Gambella (4.8%), followed by Addis Ababa (3.4%), Dire Dawa (2.5%), and Harari (2.4%) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The outcomes of some recent randomized trials have shown that rapid ART initiation, including same-day initiation, could improve program outcomes, especially by lessening loss to care in the pre-ART period [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, evidence from program settings suggests that rapid ART initiation may result in optimized loss to follow-up after ART initiation due to insufficient time to accept and disclose HIV status and prepare for lifelong treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEthiopia is one of the Sub-Saharan African countries that has committed to reaching 90% of HIV-positive people, initiating ART for 90% of those reached, virally suppressing 90% of those on ART by 2020, and ending the HIV epidemic by 2030. To achieve the three 90\u0026rsquo;s by 2020 and end the HIV epidemic by 2030, Ethiopia is implementing same-day ART initiation and differentiated service delivery (DSD) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe status of same-day ART initiation, its challenges, and benefits for retention and viral suppression remains unclear in Ethiopia. A researcher affiliated with an NGO specializing in HIV technical support for healthcare facilities in Ethiopia highlighted the challenge of lost follow-up among patients initiating same-day ART. Thus, this study aims to investigate the status of same-day ART initiation in selected healthcare facilities in Ethiopia. This study\u0026rsquo;s purpose was to evaluate same-day ART initiation status regarding retention in HIV/AIDS care at selected healthcare facilities in Ethiopia. The results of this study will assist healthcare providers, program managers, and policy designers at the federal level to understand and address factors linked with same-day ART initiation and tracing patients lost to follow-up from HIV/AIDS care in Ethiopia\u0026rsquo;s healthcare services.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003e This study, was conducted in two health care facilities in Adama and Bishoftu towns in Oromia Regional State, East Shewa zone of Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eThe population for this study was the clinical records of patients started on ART from the 1st of October 2017 until the 30th of October 2019 in two healthcare facilities in Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eResearch design\u003c/h2\u003e \u003cp\u003eA cross-sectional study design was conducted involving retrospective document analysis of 332 clinical records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSampling and sample\u003c/h2\u003e \u003cp\u003eA probability simple random sampling technique was used in the selection of the clinical records of patients started on ART from the 1st of October 2017 until the 30th of October 2019 from selected healthcare facilities. In sample size calculation a statistician assisted and the Rao Soft formula was used to estimate the ideal sample size from each healthcare facility (Raosoft formula online [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The sample size for Healthcare Facility 1 was 158, and for Healthcare Facility 2, it was 174. Thus, the total sample size from both healthcare facilities was 332. The inclusion criteria encompassed the clinical records of patients who initiated ART on the same-day from the 1st of October 2017 until the 30th of October 2019. Additionally, the study included individuals belonging to adult age groups, defined as those aged 18 years and above.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eData for this study was collected from the clinical records of patients started on same-day ART clinic smart care databases of selected healthcare facilities. Prior to data collection, permission was obtained from both Healthcare Facility 1 and Healthcare Facility 2. To mitigate the risk of exposure to the COVID-19 pandemic, which was classified at level 1, data collection was conducted from the smart care databases. The approved permission to access clinical records used as the consent form. The researcher, supported by data clerks, exported clinical records from the healthcare facility smart care databases for analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The researcher received an ethical clearance certificate from the University of South Africa\u0026rsquo;s Department of Health studies (reference number: HSHDC/977/2020). Permission to conduct the study was used as a consent form to access clinical records of patients started on same-day ART from the smart care database for data collection. To maintain confidentiality and privacy, a number was assigned to clinical records instead of a patient\u0026rsquo;s name. Privacy was maintained by ensuring that the researcher had signed a confidentiality binding agreement, data collection was conducted by the researcher from the smart care database, and numbers were allocated to the clinical records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eIn this study data was extracted from the smart care database, and the researcher used 332 clinical records for data analysis. A checklist was used as an instrument to capture the 332 clinical data of patients started on same-day ART. The service of the statistician was used and the collected data was entered into SPSS version 28 for data analysis. Data accuracy and quality were ensured through a thorough cleaning and preparation process conducted before data analysis. Data was checked for errors, missing values, quality, consistency, suitability, and inconsistencies, which were identified and fixed before data analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eValidity and reliability\u003c/h2\u003e \u003cp\u003eIn this study, validity was assured through the application of external, internal, content, and face validity to the data collection tool. To ensure reliability, several steps were taken. These encompassed assessing a data collection checklist for its clarity and alignment with research inquiries. Additionally, both the supervisor and statistician scrutinized the instrument's reliability during the final phase. Quantitative data was directly sourced by the researcher from the smart care database.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy Variables\u003c/h2\u003e \u003cp\u003eThe study variables included gender, age, marital status, educational status, religion, patient address, patient history of opportunistic infections at enrolment, who staged at enrolment, last follow-up ARV adherence, HIV disclosure status at enrolment, last follow-up ARV adherence, and baseline BMI results. These variables were used to describe participants' health conditions, immune status, disease progression, and relevant factors that may influence ART treatment retention in care for patients started on same-day ART.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe collected data was entered into SPSS version 28 for data analysis. Data accuracy and quality were ensured through a thorough cleaning and preparation process conducted before data analysis. Data was checked for errors, missing values, quality, consistency, suitability, and inconsistencies, which were identified and fixed before data analysis. The data was analyzed using descriptive and inferential statistics. Descriptive statistics were employed to summarize key characteristics of the study population, including demographics, treatment initiation status, retention in HIV care, and viral suppression. With the assistance of a statistician, the researcher used frequencies and percentages to summarize the results using tables and graphs. Data analysis involved conducting logistic regression to examine the relationships between factors associated with retention in HIV care. The researcher calculated odds ratios (OR) with their 95% confidence intervals (95% CI) and considered p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 332 clinical records of patients\u0026rsquo; ages above 18 who started on same-day ART were utilized for the data analysis in this study. Among these records, 91 males and 67 females totaling 158 were obtained from Healthcare Facility 1, while 69 males and 105 females totaling 174 were obtained from Healthcare Facility 2. The majority of the patients, 58.7% (n\u0026thinsp;=\u0026thinsp;195), were over 35 years old; 29.5% (n\u0026thinsp;=\u0026thinsp;98) were in the age range of 25\u0026ndash;34 years; and the minority, 11.7% (n\u0026thinsp;=\u0026thinsp;39), were in the range of 18\u0026ndash;24 years. Regarding gender, the participants\u0026rsquo; females were 52% (n\u0026thinsp;=\u0026thinsp;172) and males were 48% (n\u0026thinsp;=\u0026thinsp;160). Results showed that the majority, 48.5% (n\u0026thinsp;=\u0026thinsp;161) of patients, were married; divorced patients were 21.7% (n\u0026thinsp;=\u0026thinsp;72); those who had never been married (single) were 21.4% (n\u0026thinsp;=\u0026thinsp;71); and widowed patients were 7.8% (n\u0026thinsp;=\u0026thinsp;26).\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e above illustrated the participant\u0026rsquo;s religion and indicated that the majority, 61.7% (n\u0026thinsp;=\u0026thinsp;205) were Orthodox Christians, 18.4% (n\u0026thinsp;=\u0026thinsp;61) were Protestants, 11.4% (n\u0026thinsp;=\u0026thinsp;38) were Muslims, 6.6% (n\u0026thinsp;=\u0026thinsp;22) were Catholic, and the minority, 1.8% (n\u0026thinsp;=\u0026thinsp;6) belonged to other religious groups. From the education level perspective, the results showed that that the majority, 38.3% (n\u0026thinsp;=\u0026thinsp;127) had primary education, 26.6% (n\u0026thinsp;=\u0026thinsp;95) had no formal education, 25% (n\u0026thinsp;=\u0026thinsp;83) had secondary education, and the minority, 8.1% (n\u0026thinsp;=\u0026thinsp;27) had tertiary education. The majority, 72% (n\u0026thinsp;=\u0026thinsp;239) of patients, were from urban areas, while the minority, 28% (n\u0026thinsp;=\u0026thinsp;93) of patients were from rural areas and the majority, 89% (n\u0026thinsp;=\u0026thinsp;294) had their phone numbers documented, 89% (n\u0026thinsp;=\u0026thinsp;294), had documented kebele information. The majority, 78.6% (n\u0026thinsp;=\u0026thinsp;261) of patients, had a registered house number, and the minority, 21.4% (n\u0026thinsp;=\u0026thinsp;71), of patients did not.\u003c/p\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eBaseline clinical and laboratory information\u003c/h2\u003e\n\u003cp\u003eThe variables included in the in the baseline clinical and laboratory information were patients' histories of opportunistic illness, types of opportunistic infections, baseline BMI, functional status, WHO clinical staging of HIV, patients' HIV disclosure status, patients' CD4 cell count at baseline, and the actual CD4 value at baseline.\u003c/p\u003e\n\u003cp\u003eThe majority, 94.3% (n\u0026thinsp;=\u0026thinsp;313) patients had no opportunistic infections at enrolment, while the minority, 5.7% (n\u0026thinsp;=\u0026thinsp;19) of the patients had opportunistic infections at enrolment. Among OIs the majority, 68% (n\u0026thinsp;=\u0026thinsp;13) of opportunistic infections were tuberculosis, 16% (n\u0026thinsp;=\u0026thinsp;3), pneumocystis pneumonia (PCP), 11% (n\u0026thinsp;=\u0026thinsp;2), toxoplasmosis, and the minority, 5% (n\u0026thinsp;=\u0026thinsp;1) belonged to other opportunistic infections.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eFrequency distribution of baseline BMI status (N\u0026thinsp;=\u0026thinsp;332)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBMI category\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency (N)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCumulative percent\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e205\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e332\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e indicated that the majority 61.7% (n\u0026thinsp;=\u0026thinsp;205) of patients had a BMI between 18.5 and 24.9 kg/m\u0026sup2;, 28.3% (n\u0026thinsp;=\u0026thinsp;94), fell within the range of 25 to 29.9 kg/m\u0026sup2;, and the minority 7.5% (n\u0026thinsp;=\u0026thinsp;25) had a BMI below 18.5 kg/m\u0026sup2;.\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e indicated that the majority, 63.3% (n\u0026thinsp;=\u0026thinsp;210), had a normal nutritional status, 7.5% (n\u0026thinsp;=\u0026thinsp;25) were overweight, 6.6% (n\u0026thinsp;=\u0026thinsp;22) had moderate malnutrition, 6% (n\u0026thinsp;=\u0026thinsp;20) had severe malnutrition, and the minority, 2.4% (n\u0026thinsp;=\u0026thinsp;8), were obese.\u003c/p\u003e\n\u003cp\u003eRegarding the functional status of study participants, the majority, 90.7% (n\u0026thinsp;=\u0026thinsp;301) were able to work, 6.3% (n\u0026thinsp;=\u0026thinsp;21) were ambulatory (able to walk), 2.7% (n\u0026thinsp;=\u0026thinsp;9) were bedridden, and the minority, 0.3% (n\u0026thinsp;=\u0026thinsp;1) were not assessed for their functional status. The results showed that the majority, 63.3% (n\u0026thinsp;=\u0026thinsp;210), had a normal nutritional status, 7.5% (n\u0026thinsp;=\u0026thinsp;25) were overweight, 6.6% (n\u0026thinsp;=\u0026thinsp;22) had moderate malnutrition, 6% (n\u0026thinsp;=\u0026thinsp;20) had severe malnutrition, and the minority, 2.4% (n\u0026thinsp;=\u0026thinsp;8), were obese. The participants WHO staging results showed that the majority, 54% (n\u0026thinsp;=\u0026thinsp;180), belonged to WHO stage I, 26% (n\u0026thinsp;=\u0026thinsp;87) were stage II, 15% (n\u0026thinsp;=\u0026thinsp;51) were stage III, and the minority, 4% (n\u0026thinsp;=\u0026thinsp;14), were stage IV.\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e above, intimated that the majority, 53.6% (n\u0026thinsp;=\u0026thinsp;178), of the patients did not inform anyone about their HIV status including their spouses or families, while the minority, 46.4% (n\u0026thinsp;=\u0026thinsp;154) had disclosed their HIV status to family or friends.\u003c/p\u003e\n\u003cp\u003eRegarding baseline CD4 the results showed that the majority, 65.1% (n\u0026thinsp;=\u0026thinsp;216), did not have baseline CD4 results, while the minority, 34.9% (n\u0026thinsp;=\u0026thinsp;116), had baseline CD4 test results. Among those who had CD4 results the majority, 29.3% (n\u0026thinsp;=\u0026thinsp;34) had CD4 results\u0026thinsp;\u0026lt;\u0026thinsp;200 cells/mm3, 26.7% (n\u0026thinsp;=\u0026thinsp;31) 200\u0026ndash;349 cells/mm3, 17.2% (n\u0026thinsp;=\u0026thinsp;20) 350-499cells/mm3 and the minority, 26.7% (n\u0026thinsp;=\u0026thinsp;31)\u0026thinsp;\u0026ge;\u0026thinsp;500 cells/mm3.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eSame-day ART initiation status related information\u003c/h2\u003e\n\u003cp\u003eThe role of the HIV testing unit is crucial in facilitating the same-day initiation of ART. This included patients who were identified as HIV positive in other healthcare facilities and referred for ART initiation, which could sometimes cause delays in same-day ART initiation. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e showed that the majority, 27.7% (n\u0026thinsp;=\u0026thinsp;92) were from the voluntary counselling and testing (VCT) unit, 24.4% (n\u0026thinsp;=\u0026thinsp;69) were from the ART clinic, 19.9% (n\u0026thinsp;=\u0026thinsp;66) were referred from other healthcare facilities, and the minority, 7.2% (n\u0026thinsp;=\u0026thinsp;24) were linked from other service delivery points within the healthcare facility.\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e below illustrates the majority of the patients, 48% (n\u0026thinsp;=\u0026thinsp;160), were in HIV care for less than 6 months, 22% (n\u0026thinsp;=\u0026thinsp;73) were 13\u0026ndash;18 months, 19% (n\u0026thinsp;=\u0026thinsp;63) were 6\u0026ndash;12 months and the minority, 11% (n\u0026thinsp;=\u0026thinsp;36) were 19\u0026ndash;24 months on ART. These results indicated that a significant number of patients who started on same-day ART were lost before reaching the six-month period.\u003c/p\u003e\n\u003cp\u003eThe results indicated that the majority, 59% (n\u0026thinsp;=\u0026thinsp;196), were in HIV care, 27% (n\u0026thinsp;=\u0026thinsp;90) were lost to follow-up, 7% (n\u0026thinsp;=\u0026thinsp;25) were confirmed dead, and the minority, 6% (n\u0026thinsp;=\u0026thinsp;21), were transferred out to another healthcare facility.\u003c/p\u003e\n\u003cp\u003eThe retention status of patients started on same-day ART varies months and the results showed that that retention at 6 months was 35% (n\u0026thinsp;=\u0026thinsp;49), at 12 months it was 81% (n\u0026thinsp;=\u0026thinsp;50), from 13 to 18 months it was 89% (n\u0026thinsp;=\u0026thinsp;63), and at 24 months it was 94% (n\u0026thinsp;=\u0026thinsp;34) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn the logistic regression analysis, a total of 311 clinical records from patients who initiated same-day ART were included, while 21 clinical records of those transferred to other healthcare facilities were omitted due to the fact that their final outcomes were not known. The logistic regression model indicated that, when adjusting for the effect of the other variables, the effect of age group on retention was not significant. The study\u0026rsquo;s logistic regression analysis revealed that gender has a significant effect on retention (\u0026beta;\u0026thinsp;=\u0026thinsp;2.890, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003cp\u003eThe study results also showed that when the effect of the other variables was controlled, the odds of being retained differed significantly by level of education. The odds of being retained when a tertiary education was 0.2 times greater than no formal education, that is, (\u0026beta;\u0026thinsp;=\u0026thinsp;0.212, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, the odds of being retained when a tertiary education was 0.13 times more than a secondary education, which is (\u0026beta;\u0026thinsp;=\u0026thinsp;0.131, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The type of residential area also has a significant effect on retention; patients who reside in urban areas were more likely to be retained than those who reside in rural areas, that is, (\u0026beta;\u0026thinsp;=\u0026thinsp;0.467, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eThe results also showed that adherence to ARV significantly affects retention, such that patients with a good level of adherence were 0.1 times more likely to be retained in comparison to those with a fair level of adherence (\u0026beta;\u0026thinsp;=\u0026thinsp;0.092, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Similarly, patients with a good level of adherence were 0.11 times more likely to be retained in comparison with those with a poor level of adherence (\u0026beta;\u0026thinsp;=\u0026thinsp;0.110, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The results of the study revealed that considering the functional status at the final follow-up, the likelihood of retention was 0.17 times greater among working functional status of patients compared to those who were ambulatory, with a coefficient (\u0026beta;\u0026thinsp;=\u0026thinsp;0.167) and a significance level of (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The study results further showed that the likelihood of retention was 0.37 times higher for patients in stage I compared to stage II. Patients with WHO stage II were more likely to be retained in HIV care compared to stage I (\u0026beta;\u0026thinsp;=\u0026thinsp;0.373, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Patient age, marital status, religion, the presence of opportunistic infections, and baseline BMI were not significantly related to retention in HIV care (refer to Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eLogistic regression analysis of retention (N\u0026thinsp;=\u0026thinsp;311)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRetention status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eOdds Ratio\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eStd. Err.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003ez\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eP\u0026gt;|z|\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e95% Conf. Interval\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRetained\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot retained\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78 (52.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70 (47.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118 (72.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (27.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.890\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.985\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.481\u0026ndash;5.64\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u0026ndash;24 years (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (59.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 (40.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52 (55.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41 (44.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.241\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.123\u0026ndash;1.303\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;35 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122 (67.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59 (32.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.166\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 .692\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.260\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.364\u0026ndash;3.735\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 (52.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (47.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e103 (65.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54 (34.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.566\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.729\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.628\u0026ndash;3.903\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDivorced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44 (63.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 (36.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.245\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.689\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.420\u0026ndash;3.684\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWidowed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (72.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (27.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.386\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.717\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.520\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.702\u0026ndash;16.323\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eEducational status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo formal education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55 (61.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 (38.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.211\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.152\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.031\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.051\u0026ndash;0.870\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79 (66.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (33.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.296\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.210\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.086\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.073\u0026ndash;1.189\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40 (51.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37 (48.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.094\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.031\u0026ndash;0.538\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTertiary (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (81.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (18.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eReligion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProtestant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 .518\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.215\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.114\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0..230\u0026thinsp;\u0026minus;\u0026thinsp;1.170\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCatholic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (76.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (23.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.149\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.051\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.078\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.878\u0026ndash;11.293\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOrthodox (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132 (65.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69 (34.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (60.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (39.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.553\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.912\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.380\u0026ndash;2.951\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePatients address\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrban (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e153 (67.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74 (32.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRural\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43 (51.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41 (48.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.466\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.172\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.039\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.226\u0026ndash;0.962\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePatient history of OI enrolment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (61.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (38.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e185 (63.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e108 (36.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.116\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.889\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.368\u0026ndash;12.171\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eWHO clinical staging of HIV at enrolment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStage I (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112 (66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56 (33.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStage II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (53.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (46.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 .373\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.180\u0026ndash;0.774\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStage III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 (68.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 (31.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.297\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.652\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.604\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.484\u0026ndash;3.475\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStage IV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (58.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (41.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 .907\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.069\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.935\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.090\u0026ndash;9.144\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eLast follow-up ARV adherence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGood (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122 (81.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (18.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFair\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74 (46)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87 (54)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.091\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.076\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.017\u0026ndash;0.471\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePoor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e191 (68.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88 (31.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.017\u0026ndash;0.679\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePatient have disclosed HIV status at enrolment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (13.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (86.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (17.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (82.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 .155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.054\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.077\u0026ndash;0.310\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eBaseline BMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNormal (ref)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e123 (63.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70 (36.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMild/moderate malnutrition\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38 (56.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (43.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.717\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.387\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.337\u0026ndash;1.522\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSevere malnutrition\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (63.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (36.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.751\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.321\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.457\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.399\u0026ndash;7.682\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOver/obese weight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 (71.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (28.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 .537\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.306\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.276\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.175\u0026ndash;1.643\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results showed that females had a higher prevalence of HIV infection compared to males due to their increased vulnerability in relation to males. A study which concurred with this study was conducted in South Africa on the same-day initiation of antiretroviral therapy for HIV-infected individuals, revealed that female enrolment was 74.1% (n\u0026thinsp;=\u0026thinsp;9663), while males about 25.9% (n\u0026thinsp;=\u0026thinsp;3375) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In contrast to this study, a study was conducted in Addis Ababa, Ethiopia, on antiretroviral therapy service quality and associated factors at public hospitals revealed that a higher proportion of male patients, 67.1% (n\u0026thinsp;=\u0026thinsp;282), were enrolled as compared to female patients, which was 32.9% (n\u0026thinsp;=\u0026thinsp;138) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding the marital status, the study revealed that the majority of patients, were married and this indicated that the prevalence of HIV among married couples was high due to a lack of HIV testing prior to and during marriage. A study which concurred with this study was conducted in Ethiopia on pre-marital HIV testing among married women, revealed that only 21.4% (n\u0026thinsp;=\u0026thinsp;2142) of the married couples had undergone pre-marital HIV testing [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In contrast with this study, a study was conducted in Eswatini, focused on the impact of same-day ART initiation under the World Health Organization's treat-all policy, found that the majority, 69.2% (n\u0026thinsp;=\u0026thinsp;566) of patients on same-day ART were not married [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study revealed that the majority had primary education, which revealed that HIV prevalence was high in patients who had no formal education or primary education. A study which concurred with this study was conducted in Masaka, Uganda, on factors related to loss to follow-up (LTFU) among HIV-positive patients receiving ART, revealed that patients with no formal education had a higher risk of lost to follow-up compared to those with a post-secondary education level (AHR\u0026thinsp;=\u0026thinsp;0.50; 95% CI, 0.34\u0026ndash;0.75) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In contrast with this study, the study conducted in Togo on health-related quality of life among people living with HIV/AIDS, which revealed that the majority, 45.4% (n\u0026thinsp;=\u0026thinsp;399), had secondary and higher education, 37% (n\u0026thinsp;=\u0026thinsp;326) had primary education, and the minority, 17.6% (n\u0026thinsp;=\u0026thinsp;155), had no education, which showed that the majority of patients had secondary and higher education compared to this study [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study found that the majority, had their phone numbers documented. These results indicated that the majority of patients could be reached if lost through their phone number, and female patients were more likely to have a phone address and could be reachable compared to male patients. A study which concurred with this study was conducted in Kampala, Uganda, on factors associated with retention and non-viral suppression among HIV-positive patients on ART, revealed that the majority, 94.2% (n\u0026thinsp;=\u0026thinsp;259) had a phone number, while the minority, 5.8% (n\u0026thinsp;=\u0026thinsp;16), did not have a phone number [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study showed that the majority, of patients, had a registered house number, and these results implied that the majority of patients did not have their exact location documented or house number, which played a role in home-to-home tracing for those lost from HIV care. Having a specific address is crucial in HIV prevention, care, and treatment for various reasons. A study which concurred with this study was conducted in rural Mozambique, focused on loss to follow-up and opportunities for reengagement in HIV care, found that the majority, 61.6% (n\u0026thinsp;=\u0026thinsp;691) were reported lost to follow-up due to a lack of proper, specific document addresses [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study showed that the majority, of opportunistic infections were tuberculosis which indicated that among patients initiated on same-day ART, tuberculosis was the most prevalent opportunistic infection, leading to co-morbidity and poor adherence due to pill burden. A study which concurred with this study was conducted in Haiti on the importance of integrated care for HIV and TB co-infection; prompt initiation of both ART and TB treatment can enhance outcomes and address the dual burden of HIV and TB. It revealed that 77.1%(n\u0026thinsp;=\u0026thinsp;37) of patients who started on same-day ART had a TB infection at enrolment [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In contrast to this study, a study was conducted at Gondar University Comprehensive and Specialized Hospital, Ethiopia, on the incidence of opportunistic infections and its predictors among HIV/AIDS patients, revealed that the majority, 16.51% (n\u0026thinsp;=\u0026thinsp;90) had pneumocystis\u0026rsquo; pneumonia 16.33% (n\u0026thinsp;=\u0026thinsp;89), had chronic diarrhea 10.82% (n\u0026thinsp;=\u0026thinsp;59), had bacterial pneumonia and 10.46% (n\u0026thinsp;=\u0026thinsp;57) had pulmonary tuberculosis which implied that TB was the 4th opportunistic infection [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Another study which differed with this study was conducted in Kinshasa, Democratic Republic of Congo, found that the majority, 45.4% (n\u0026thinsp;=\u0026thinsp;54), had malaria and 29.4% (n\u0026thinsp;=\u0026thinsp;35) TB which implied that TB was the 2nd opportunistic infections [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study indicated that the majority belonged to WHO stage I which showed that a considerable portion of patients who began same-day ART had early-stage HIV infections with minimal symptoms, enabling them to take their medication more easily while limiting the potential for stigma and discrimination. On the other hand, patients who were ambulatory or bedridden required specialized care to facilitate medication adherence and needed additional resources or manpower to take their medication. A study which concurred with this study was conducted at Nekemte Specialized Hospital in Western Ethiopia, which focused on same-day ART initiation and its associated factors, revealed that the majority, 77.02% (n\u0026thinsp;=\u0026thinsp;372) belongs to stage I, 14.08% (n\u0026thinsp;=\u0026thinsp;67) were classified as stage II, and the minority, 8.91% (n\u0026thinsp;=\u0026thinsp;43), of patients were classified as stages II and IV [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this regard, results of this study differed with the study conducted in Malang, East Java, Indonesia, on functional status and incidence of loss to follow-up after ART initiation, which revealed that the majority, 35.8% (n\u0026thinsp;=\u0026thinsp;53) were WHO stage III, 27% (n\u0026thinsp;=\u0026thinsp;40) were WHO stage IV, 22.9% (n\u0026thinsp;=\u0026thinsp;34) were WHO stage I, and the minority, 14.1% (n\u0026thinsp;=\u0026thinsp;21), were WHO stage II, which showed the majority belongs to WHO stage III compared to this study, in which the majority belongs to WHO stage I [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study showed the majority of the patients, were in HIV care for less than 6 months, which indicated that a significant number of patients who started on same-day ART were lost before reaching the six-month period. A study which concurred with this study was conducted in South African public health facilities, focusing on same-day ART initiation, reported that 33% (n\u0026thinsp;=\u0026thinsp;11,114) of patients initiated on the same-day were classified as lost to follow-up, with a median time to loss of 55 days [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. According to Joseph Davey et al [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], the results showed a retention rate of approximately 67% (n\u0026thinsp;=\u0026thinsp;22,565) at six months, which aligns with the results of this study.\u003c/p\u003e \u003cp\u003eThe study indicated that the majority were lost to follow-up, and results implied that Ethiopia was significantly below the UNAIDS target of achieving 95% retention in HIV care by 2030. Furthermore, the results indicated an effort should be made to retain patients in HIV care after same-day ART initiation for the first six months. A study which was concurred with this study was conducted in South Africa on same-day ART initiation for HIV-infected adults revealed that the majority, 64.4% (n\u0026thinsp;=\u0026thinsp;8399) were active in care, 29.2% (n\u0026thinsp;=\u0026thinsp;3804) were lost, 6.1% (n\u0026thinsp;=\u0026thinsp;793) were transferred out to other healthcare facilities and the minority,0.3% (n\u0026thinsp;=\u0026thinsp;42) were died [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Similarly, data reported by 72 countries as a global update towards terminating AIDS progress towards the 90\u0026ndash;90\u0026ndash;90 targets revealed that retention on antiretroviral therapy after 12 months ranged from 72% in Western and Central Africa to 89% in the Middle East and North Africa, which concurred with this study results [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, a study was conducted in Kenya at the Kibera community health center HIV/AIDS program on retention of patients in HIV care revealed that the majority, 79% (n\u0026thinsp;=\u0026thinsp;67), were in care, 14% (n\u0026thinsp;=\u0026thinsp;12) were lost, 6% (n\u0026thinsp;=\u0026thinsp;5) were transferred to other healthcare facilities, and the minority, 1% (n\u0026thinsp;=\u0026thinsp;1), were died [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study showed that retention at 6 months was low which implied that retention in HIV care improved significantly after the initial six months of ART initiation. A study which concurred with this study was conducted in rural Mozambique on poor retention and care-related sex disparities among youth living with HIV, revealed that overall retention was 49% (n\u0026thinsp;=\u0026thinsp;12,179) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Contrary, a study that was conducted in Italy on the impact of rapid initiation of ART at HIV diagnosis on virological response in a real-life setting, indicated that the majority, 94.4% (n\u0026thinsp;=\u0026thinsp;302), of patients were in HIV care at six months [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Two (2) provinces of the Democratic Republic of the Congo on factors associated with the retention of HIV patients on antiretroviral therapy (ART) in HIV care and revealed an overall retention rate of 78.2% (n\u0026thinsp;=\u0026thinsp;38906), which was higher compared to the retention rate observed in this study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitation of the study\u003c/h2\u003e \u003cp\u003eThe study faced several limitations exacerbated by COVID-19 pandemic restrictions, notably hindering face-to-face data collection. Additionally, its retrospective nature introduces potential recall bias among patients recalling details of same-day ART initiation and follow-up events. Reliance on self-reported data may further introduce social desirability bias. Data incompleteness from the smart care database and challenges retrieving patient folders compounded the limitations. External factors like strategy changes during the study period could also influence outcomes. The cross-sectional design limited tracking longitudinal changes in patient outcomes. Furthermore, restrictions during the pandemic prevented inclusion of religious leaders and community-level associations of people living with HIV. Recognizing these limitations is crucial for informing future research and refining understanding of same-day ART initiation and associated challenges.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study aimed to evaluate the same-day ART initiation status regarding retention of patients in HIV/AIDS. The study highlighted the significance of same-day antiretroviral therapy (ART) initiation in bolstering retention rates among HIV/AIDS patients receiving care in Ethiopia. Various factors, including gender, education level, urban residence, adherence, functional status, and WHO stage, exert notable influences on retention rates. By addressing these factors through targeted interventions, sustained enhancements in HIV care can be achieved, thus propelling progress towards the goal of eradicating the epidemic by 2030. This study results demonstrated the impact of same-day ART initiation on patient retention within Ethiopian HIV/AIDS care. With an overall retention rate of 59%, the implementation of same-day ART initiation strategies emerges as pivotal in improving patient outcomes in Ethiopia's HIV/AIDS care landscape. This study provides valuable insights into same-day ART initiation, lost to follow-up, and retention in HIV care at healthcare facilities in Ethiopia. Recommendations emphasize a holistic approach to same-day ART initiation, focusing on improved counselling, capacity building, and education. Multiple counselling sessions led by healthcare providers can address patient concerns and enhance treatment adherence through increased awareness.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate the study was approved by the research and Ethics Committee of the University of South Africa\u0026rsquo;s Department of Health (reference number: HSHDC/977/2020) the Oromia Regional Health Bureau and healthcare facilities where study was conducted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis publication does not contain any individual person\u0026rsquo;s identifying data in any form (including individual details, images or videos).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the results of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMr. K.H. Chachu: Conceive the study, wrote the proposal and was involved in data acquisition, data analysis, and manuscript preparation.\u003c/p\u003e\n\u003cp\u003eProfessor K.A. Maboe: advised during proposal development, result writing, and final manuscript preparation for publication.\u003c/p\u003e\n\u003cp\u003eBoth authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMy special thanks to my supervisor, Professor K.A. Maboe, for her unwavering guidance and support throughout every stage of this thesis, from its inception to its completion. I am also profoundly thankful to the University of South Africa for affording me the opportunity to learn and for their financial support. I extend my appreciation to all members of the UNISA staff and to all those who supported me in finalizing my study in any way.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEthiopia Ministry of Health. National Consolidated Guidelines for Comprehensive HIV prevention, Care and Treatment. 2018.\u003c/li\u003e\n\u003cli\u003eUNAIDS. Ethiopian country factsheets HIV and AIDS estimates. From: https://www.unaids.org/en/regionscountries/countries/ethiopia (accessed 20 January 2024). Unaids [Internet]. 2022;1\u0026ndash;6. Available from: https://aidsinfo.unaids.org/%0D.\u003c/li\u003e\n\u003cli\u003eOrganization WH. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV Infection: Recommendations for a public health approach. 2nd edition. 2016. \u003c/li\u003e\n\u003cli\u003eFederal HIV/AIDS Prevention and Control Office. 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Retention of pediatric patients in care: A study of the kibera community health center hiv/aids program. Afr Health Sci. 2021;21:39\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eAhonkhai AA, Aliyu MH, Audet CM, Bravo M, Simmons M, Claquin G, et al. Poor retention and care-related sex disparities among youth living with HIV in rural Mozambique. PLoS One. 2021 May 1;16(5 May). \u003c/li\u003e\n\u003cli\u003eGregori N, Renzetti S, Izzo I, Faletti G, Fumarola B, degli Antoni M, et al. Does the rapid initiation of antiretroviral therapy at HIV diagnosis impact virological response in a real-life setting? A single-centre experience in Northern Italy. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2023;35(12):1938\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eShah GH, Etheredge GD, Nkuta LM, Waterfield KC, Ikhile O, Ditekemena J, et al. Factors Associated with Retention of HIV Patients on Antiretroviral Therapy in Care: Evidence from Outpatient Clinics in Two Provinces of the Democratic Republic of the Congo (DRC). Trop Med Infect Dis. 2022 Sep 1;7(9). \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Clinical records, HIV, lost to follow-up, retention, same-day ART initiation","lastPublishedDoi":"10.21203/rs.3.rs-4291094/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4291094/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo meet the ambitious goal of eradicating the HIV epidemic by 2030, the Joint United Nations Programme on HIV/AIDS has set 95-95-95 targets. These targets aim for 95% of HIV-infected individuals to know their status, 95% to initiate antiretroviral therapy (ART), and 95% to achieve virologic suppression by 2030. In Ethiopia, progress towards these targets has been made, but challenges persist. This study aims to evaluate same-day ART initiation status regarding retention of patients in HIV/AIDS care at the healthcare facility level in Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study design was conducted involving retrospective document analysis of 332 clinical records. The study included clinical records of patients initiated on same-day ART from the 1st of October 2017 until the 30th of October 2019. Data was analyzed quantitatively, descriptive and inferential statistical analyses were performed using Statistical Package for Social Science (SPSS) version 28.0 software. Data analysis involved conducting logistic regression to examine the relationships between factors associated with retention in HIV care.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results indicated varying retention rates over different time intervals: 35% at 6 months (n\u0026thinsp;=\u0026thinsp;49), 81% at 12 months (n\u0026thinsp;=\u0026thinsp;50), 89% from 13 to 18 months (n\u0026thinsp;=\u0026thinsp;63), and 94% at 24 months (n\u0026thinsp;=\u0026thinsp;34), with an overall retention in HIV/Care at 59% (n\u0026thinsp;=\u0026thinsp;196). The study\u0026rsquo;s logistic regression analysis revealed that gender has a significant effect on retention (β\u0026thinsp;=\u0026thinsp;2.890, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), tertiary education was 0.2 times greater than no formal education, that is, (β\u0026thinsp;=\u0026thinsp;0.212, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), tertiary education was 0.13 times more than a secondary education, which is (β\u0026thinsp;=\u0026thinsp;0.131, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), patients who reside in urban areas were more likely to be retained than those who reside in rural areas, that is, (β\u0026thinsp;=\u0026thinsp;0.467, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), patients with a good level of adherence were 0.1 times more likely to be retained in comparison to those with a fair level of adherence (β\u0026thinsp;=\u0026thinsp;0.092, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study underscores the importance of same-day ART initiation in enhancing retention rates among patients in HIV/AIDS care in Ethiopia. Factors such as gender, education level, urban residence, adherence, functional status, and WHO stage significantly influence retention. Addressing these factors through targeted interventions is crucial for achieving sustained improvements in HIV care and advancing towards epidemic eradication goals by 2030.\u003c/p\u003e","manuscriptTitle":"Retention of patients in HIV/AIDS care at the healthcare facility level in Ethiopia: Same-day antiretroviral initiation status","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-29 15:06:25","doi":"10.21203/rs.3.rs-4291094/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6890c205-ac64-4bcc-9b0b-22561d952454","owner":[],"postedDate":"April 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-21T05:08:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-29 15:06:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4291094","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4291094","identity":"rs-4291094","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}