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Infectious diseases
Research
The magnitude of, and factors associated with, loss to follow-up among patients treated for sexually transmitted infections: a multilevel analysis
  1. Mache Tsadik1,
  2. Yemane Berhane2,
  3. Alemayehu Worku3,
  4. Wondwossen Terefe1
  1. 1 College of Health Science, Mekelle University, Tigray, Ethiopia
  2. 2 Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
  3. 3 Addis Ababa University, Addis Ababa, Ethiopia
  1. Correspondence to Dr Mache Tsadik; adhana2008{at}gmail.com

Abstract

Objectives The loss to follow-up (LTFU) among patients attending care for sexually transmitted infections (STIs) in Sub-Saharan Africa is a major barrier to achieving the goals of the STI prevention and control programme. The objective of this study was to investigate individual- and facility-level factors associated with LTFU among patients treated for STIs in Ethiopia.

Methods A prospective cohort study was conducted among patients attending care for STIs in selected facilities from January to June 2015 in the Tigray region of Ethiopia. LTFU was ascertained if a patient did not present in person to the same facility within 7 days of the initial contact. Multilevel logistic regression was used to identify factors associated with LTFU.

Results Out of 1082 patients, 59.80% (647) were LTFU. The individual-level factors associated with LTFU included having multiple partners (adjusted OR (AOR) 2.89, 95% CI 1.74 to 4.80), being male (AOR 2.23, 95% CI 1.63 to 3.04), having poor knowledge about the means of STI transmission (AOR 2.08, 95% CI 1.53 to 2.82), having college level education (AOR 0.38, 95% CI 0.22 to 0.65), and low perceived stigma (AOR 0.60, 95% CI 0.43 to 0.82). High patient flow (AOR 3.06, 95% CI 1.30 to 7.18) and medium health index score (AOR 2.80, 95% CI 1.28 to 6.13) were facility-level factors associated with LTFU.

Conclusions Improving patient retention in STI follow-up care requires focused interventions targeting those who are more likely to be LTFU, particularly patients with multiple partners, male index cases and patients attending facilities with high patient flow.

  • sexually transmitted infections
  • partner notification
  • loss to follow-up
  • multilevel analysis

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-016864

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    Footnotes

    • Contributors The study was designed by MT, YB, AW and WT. MT was responsible for data collection, analysis and drafting the manuscript. YB revised the study design and the manuscript. AW supervised the data collection and analysis, revised the manuscript, and contributed to interpretation of the analysis. WT participated in the analysis and interpretation of the data, as well as revised the manuscript. All authors have read and approved the final manuscript.

    • Funding The study is funded by Mekelle University and African Population Health Research Center (APHRC). The funders had no role in the gathering or analysis of the data and no role in the writing of the manuscript or the decision to submit for publication.

    • Competing interests None declared.

    • Ethics approval Health research Ethical review committee, Mekelle University.

    • Provenance and peer review Not commissioned; externally peer reviewed.