Gender differences in mortality and loss to follow-up among HIV-positive patients on antiretroviral therapy in Tigray, Ethiopia

  • Raffaella Bucciardini Istituto Superiore di Sanità
  • Paola Tatarelli
  • Esayas Haregot Hilawe
  • Vincenzo Fragola
  • Teshome Abegaz
  • Stefano Lucattini
  • Atalilt Halifom
  • Eskedar Tadesse
  • Micheal Berhe
  • Paola De Castro
  • Massimiliano Di Gregorio
  • Katherina Pugliese
  • Roberta Terlizzi
  • Stefano Vella
  • Hagos Godefay

Abstract

Aim/Purpose

In Ethiopia data concerning the influence of gender on mortality and loss to follow-up are controversial. Our study is intended to further investigate gender-related differences in antiretroviral therapy (ART) outcomes in Tigray (Ethiopia).

Methods

We used data from the “Cohort of African people Starting Antiretroviral therapy’ (CASA) project, a prospective study of a cohort of HIV-positive patients who started ART in Tigray. The study population included HIV-positive patients starting ART between January 2013 and December 2015. Baseline characteristics were compared between men and women using Kruskal Wallis t-test and Chi-squared test. Kaplan-Meier method was used to estimate the probability of mortality and loss to follow-up for men and women. Univariate and multivariate Cox Proportional Hazards models were used to compare differences in ART outcomes by gender.

Results

The study population included 1622 patients, 1003 (61.84%) women and 619 (38.16) men. Median follow-up time was 2.6 years and 2.1 years, respectively for women and men. In the multivariate analysis men had a significantly higher risk of loss to follow-up than women (aHR 2.83, 95% CI: 2.00-4.01); but no significant sex differences in mortality was observed (aHR 1.19, 95% CI: 0.76-1.84).

Conclusions

Findings showed gender-related differences in loss to follow-up, not in mortality. Several structural and social factors may influence the gender difference in loss to follow-up. However, specific investigations are needed to get a better understanding of the reasons why men are more likely to be lost to follow-up than women and programmes with a gender-oriented approach should be implemented.

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Published
2019-06-28
Section
Original Article