Body and mind: retention in antiretroviral treatment care is improved by mental health training of care providers in Ethiopia

Tezera Moshago Berheto, Sven Gudmund Hinderaker, Mbazi Senkoro, Hannock Tweya, Tekalign Deressa, Yimam Getaneh, Gulilat Gezahegn

Ethiopia has achieved a high coverage of antiretroviral treatment (ART), but maintaining lifelong care is still a great challenge. Mental illnesses often co-exist with HIV/AIDS and may compromise the retention on ART. In order to improve prolonged retention in ART care, basic training in mental health care was introduced for ART providers, but this hasn't been evaluated yet. The aim of this study was to examine if this training has improved patient retention in care. A retrospective cohort study was employed to compare attrition from ART between clients attended by care provider trained with basic mental health service (exposed) and those in the standard ART follow-up care (unexposed) in public health facilities. A routine patient follow-up electronic database enrolled for ART between 2005 and 2017 was abstracted for the study. The Kaplan-Meier plot was used to compare the attrition rates between the two groups. The log-rank test was used to assess differences in the groups. The Cox proportional hazards regression model was used to determine predictors of attrition. We used estimated effect size of hazard ratios (HR) with 95% confidence intervals (CI). During the 12 years of observation, 8009 study participants under ART were followed for 33,498 person-years. The incidence of attrition was 6.5 per 100 person-years and 21% higher in the unexposed group (HR 1.21; 95% CI 1.1, 1.3), and retention in care was significantly higher in the mental health exposed group throughout the study period. WHO clinical staging III/IV, tuberculosis coinfection, the male gender, and poor functional status were independent risk factors for attrition. We found that clients in the group exposed to mental health care training tended to have better retention in ART care with some variation according to gender, WHO Clinical stage and functional status. Training of ART providers in mental health may be considered in order to strengthen ART retention in low resource settings.