Background: Retention in care and treatment services is critical to health outcomes of individuals diagnosed
and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult
HIV population on ART in Nigeria.
Method: A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos
University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various
sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was
TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for
periods ≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression
Result: Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate
(IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR
0.99; 95% CI 0.98 - 0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24;
95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95%
CI: 1.12-1.40) and average percent adherence to drug refill visits <95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40).
Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95%
CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86).
Conclusion: Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich
countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had
significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment
discontinuation and improve retention, especially within the first year of ART.