International Scholarly Research Network ISRN AIDS Volume 2012, Article ID 721720, 9 pages doi:10.5402/2012/721720 Research Article High Loss to Followup and Early Mortality Create Substantial Reduction in Patient Retention at Antiretroviral Treatment Program in North-West Ethiopia Mamo Wubshet, 1 Yemane Berhane, 2 Alemayehu Worku, 2 Yigzaw Kebede, 1 and Ermias Diro 1 1 Institute of Public Health, University of Gondar, P.O. Box 196, Gondar, Ethiopia 2 Addis Continental Institute of Public Health, P.O. Box 26751/1000, Addis Ababa, Ethiopia Correspondence should be addressed to Mamo Wubshet, mamo wubshet@yahoo.com Received 15 March 2012; Accepted 3 April 2012 Academic Editors: D. Aunis, C. A. Hughes, F. Krebs, and P. Price Copyright © 2012 Mamo Wubshet et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. There has been a rapid scale up of antiretroviral therapy (ART) in Ethiopia since 2005. We aimed to evaluate mortality, loss to followup, and retention in care at HIV Clinic, University of Gondar Hospital, north-west Ethiopia. Method. A retrospective patient chart record analysis was performed on adult AIDS patients enrolled in the treatment program starting from 1 March 2005. We performed survival analysis to determine, mortality, loss to followup and retention in care. Results. A total of 3012 AIDS patients were enrolled in the ART Program between March 2005 and August 2010. At the end of the 66 months of the program initiation, 61.4% of the patients were retained on treatment, 10.4% died, and 31.4% were lost to followup. Fifty-six percent of the deaths and 46% of those lost to followup occurred in the first year of treatment. Male gender (adjusted hazard ratio (AHR) was 3.26; 95% CI: 2.19–4.88); CD4 count ≤200 cells/μL (AHR 5.02; 95% CI: 2.03–12.39), tuberculosis (AHR 2.91; 95% CI: 2.11–4.02); bed-ridden functional status (AHR 12.88; 95% CI: 8.19–20.26) were predictors of mortality, whereas only CD4 count <200 cells/μL (HR = 1.33; 95% CI: (0.95, 1.88) and ambulatory functional status (HR = 1.65; 95% CI: (1.22, 2.23) were significantly associated with LTF. Conclusion. Loss to followup and mortality in the first year following enrollment remain a challenge for retention of patients in care. Strengthening patient monitoring can improve patient retention AIDS care. 1. Background Ethiopia is one of the few countries with the highest number of people living with HIV/AIDS globally. According to Ethiopian Demographic and Health Survey (EDHS) 2011, Federal Ministry of Health (FMOH) and HIV/AIDS Pre- vention and Control Office (HAPCO) estimated that adult HIV prevalence was 1.5% of which 73,000 people require ART 2010 [1]. A fee-based ART program in 2003, and a free antiretroviral therapy (ART) program in early 2005 was started [2]. Subsequently, a number of initiatives have been undertaken to expand the availability of ART in Ethiopia. Task shifting and decentralization of the service to increasing numbers of both health centers and hospitals was done since August 2006 [3]. The provision of antiretroviral treatment has decreased morbidity and mortality in people living with HIV [3–7]. There have been several enabling factors for rapid scale-up of ART in resource-limited settings. Despite recent progress in improving access to ART, limited uptake, poor retention, and difficulties in accessing care remain a serious concern for ART programs [3, 4, 8–10]. Treatment discontinuation raises some of the concern about drug resistance, which incomplete adherence does, and negates much of the benefit sought by those implementing treatment programs [11, 12]. Patients with clinical AIDS who discontinue ART will likely die within a relatively short time [13]. Long-term retention of patients in treatment programs has received far less attention perhaps because most large- scale treatment providers have few resources available to