Gender differences in death and loss to follow-up among HIV-positive patients on antiretroviral therapy in Tigray, Ethiopia

Raffaella Bucciardini, Paola Tatarelli, Esayas Haregot Hilawe, Vincenzo Fragola, Teshome Abegaz, Stefano Lucattini, Atakilt Halifom, Eskedar Tadesse, Micheal Berhe, Paola De Castro, Massimiliano Di Gregorio, Katherina Pugliese, Roberta Terlizzi, Stefano Vella, Hagos Godefay

Research output: Contribution to journalReview articlepeer-review


Background: In Ethiopia data concerning the influence of gender on death associated with HIV/AIDS and loss to follow-up in care and treatment are controversial. Objective: Our study intended to further investigate gender-related differences in antiretroviral therapy outcomes in Tigray (Ethiopia). Methods: We used data from the "Cohort of African People Starting Antiretroviral therapy' project, a prospective study of a cohort of HIV-positive patients who started ART in Tigray. The study population included HIV-positive patients starting antiretroviral therapy between January 2013 and December 2015. We compared baseline characteristics between men and women using Kruskal Wallis t-test and Chi-squared test. We employed Kaplan-Meier method to estimate the probability of mortality and loss to follow-up for men and women and univariate and multivariate Cox Proportional Hazards models to compare differences in antiretroviral therapy outcomes by gender. Results: The study population included 1,622 patients, 1,003 (61.8%) women and 619 (38.2%) men. Median follow -up time was 2.6 years and 2.1 years, respectively for women and men. In the multivariate analysis men had a significantly higher risk of loss to follow-up than women (aHR 2.8, 95% CI: 2.00-4.01); but no significant sex differences in mortality was observed (aHR 1.2, 95% CI: 0.76-1.84). Conclusions: Findings showed gender-related differences in loss to follow-up, not in mortality. Several structural and social factors may influence the gender difference in loss to follow-up. However, specific investigations are needed to get a better understanding of the reasons why men are more likely to be lost to follow-up than women and programmes with a gender-oriented approach should be implemented.

Original languageEnglish
Pages (from-to)227-233
Number of pages7
JournalEthiopian Medical Journal
Issue number3
Publication statusPublished - Jul 2019


  • Antiretroviral treatment
  • Gender difference
  • Loss- to follow-up
  • Mortality

ASJC Scopus subject areas

  • Medicine(all)


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