Predictors of loss to follow-up among youths living with HIV after transition from pediatric to adult care in Gambella, southwest Ethiopia

Introduction The transition from pediatric to adult healthcare represents a crucial period for adolescents and youth living with HIV. When this healthcare transition is not properly managed, it can result in negative outcomes such as loss of follow-up, increased morbidity, and mortality. Therefore, it is essential to investigate the factors associated with loss of follow-up among youth living with HIV who have transitioned to adult care, especially given the limited evidence available in the study area. Methods A retrospective cohort study was conducted at Gambella General Hospital with 452 HIV-positive youths enrolled in HIV care between January 1, 2019, and December 30, 2022. Data were extracted from patient charts using the Kobo Toolbox. The Kaplan-Meier survival curve was used to estimate the survival time and Log-rank tests were used to compare the survival probabilities. Bivariable and multivariable Cox proportional hazard regression models were fitted to identify predictors of loss to follow-up among youth living with HIV who have transitioned to adult care. Adjusted Hazard Ratio with 95% confidence intervals was used to assess the strength of association and statistical significance. Results The cohort followed for 1252.51 person-years of observation (PYO), exhibited an overall LTFU of 4.1 (95% CI: 3.1, 5.4) per 100 PYO. Predictors of LTFU included engaging in daily labor (AHR = 3.64; 95% CI: 1.84, 7.22), ambulatory/bedridden functional status (AHR = 2.51; 95% CI: 1.27, 4.95), suboptimal adherence to ART (AHR = 2.48; 95% CI: 1.30, 4.73), CD4 counts below 200 cells/mm3 (AHR = 3.59; 95% CI: 1.73, 7.43), and CD4 counts between 200–350 cells/mm3 (AHR = 2.85; 95% CI: 1.29, 6.32). Conclusion The study underscores LTFU as a significant public health concern among youths who transitioned to adult care. Daily labor, ambulatory/bedridden status, suboptimal ART adherence, and low CD4 counts emerged as predictors of LTFU. Therefore, interventions such as message reminders, early tracing, and targeted health education are crucial, especially for youths with poor clinical profiles. Clinical trial number not applicable.