Incidence of loss to follow-up among East African adults on antiretroviral therapy: a systematic review and meta-analysis

Background Individuals with human immunodeficiency virus receive antiretroviral treatment regardless of their clinical stage or CD4 count. While the "Universal Test and Treat" approach offers benefits, loss to follow-up remains a significant issue in sub-Saharan Africa, especially in East African countries, hindering treatment program goals. Due to inconsistent findings in previous studies, policymakers and healthcare providers struggle to implement effective interventions. This study aims to provide a pooled incidence of loss to follow-up among East African adults on antiretroviral therapy. Methods A systematic review and meta-analysis were conducted among East African adults on antiretroviral therapy. Literature was sought from PubMed, Embase, Scopus, Cochrane, and Web of Science. Additionally, we conducted hand-searching of reference lists and citation tracking of included studies. The review encompassed both retrospective and prospective follow-up articles published in English. The data extraction was completed using Covidence software and later transferred to Stata (TM) Version 18.0 for further analysis. Heterogeneity was evaluated with the aid of forest plots with the I-2 test. To explore the sources of heterogeneity, we conducted subgroup analyses, meta-regression, assessments of publication bias, and sensitivity analyses. The incidence rate of loss to follow was estimated via a random-effects meta-analysis model. Results The current meta-analysis examined 20 studies that satisfied the eligibility criteria out of the 3011 studies examined involving a total of 54,388 adults receiving antiretroviral therapy. The pooled analysis of these 20 studies established an overall incidence of loss to follow-up of 9.67 per 100 person-years of observation (95% CI, 7.84, 11.93) with I-2 of 98.5% and P-value < 0.001. With sub-group analysis, the multicountry study that includes Rwanda, Kenya, and Tanzania had the highest incidence rate of 16.7 per 100 person-years, while lower in Ethiopia with an incidence rate of 8.9 per 100 person-years. Conclusions Among adult East Africans on antiretroviral therapy, the loss to follow-up rate is projected to fail to meet the requirement set by the UN. Such insight can assist in formulating policies by identifying important factors that can help retain adults with HIV in lifelong antiretroviral treatment services.