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However, loss to follow-up (LTFU) remains a major barrier to the effectiveness of ART programs, particularly in resource-limited settings. In Ethiopia, LTFU contributes substantially to patient attrition, yet data from high-burden zones like Guji remain limited. Therefore, this study aimed to determine the incidence rate and identify predictors of loss to follow-up among HIV-infected adults receiving ART at public health facilities in Guji zone, Southern Ethiopia, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An institution-based retrospective cohort study was conducted among 434 HIV-positive adults who initiated ART between July 2018 and June 2022 at public health facilities in Guji zone. Participants were selected using simple random sampling. Data were extracted from medical records using a structured checklist and entered into Epi Data 4.6.2. Analysis was performed using SPSS 25 and STATA 14. The incidence rate of LTFU (defined as &gt;30\u2009days since last scheduled appointment date and has not been classified as \u201cdead\u201d or \u201ctransferring out) was calculated per 100 person-years. Bivariable and multivariable Cox proportional hazards regression were used to identify predictors of LTFU. Adjusted hazard ratios (AHR) with 95% confidence intervals and\n                      <jats:italic>p<\/jats:italic>\n                      -values\u2009&lt;\u20090.05 were considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Among 434 participants (60% female) followed for 904.35 person-years, 135 (31.1%) were lost to follow-up, yielding an incidence rate of 14.93 per 100 person-years. Factors significantly associated with higher LTFU risk were: male sex (AHR\u2009=\u20091.85, 95%CI: 1.27\u20132.69), age 15\u201330\u2009years (AHR\u2009=\u20092.40, 95%CI: 1.58\u20133.64), female sex work (AHR\u2009=\u20093.26, 95%CI: 1.39\u20137.65), daily labor\/mobile work (AHR\u2009=\u20091.91, 95%CI: 1.16\u20133.16), and no formal education (AHR\u2009=\u20092.20, 95%CI: 1.52\u20133.20). Protective factors associated with lower LTFU risk were: residing in the same woreda as the health facility (AHR\u2009=\u20090.55, 95%CI: 0.38\u20130.82) and having a documented phone number (AHR\u2009=\u20090.46, 95%CI: 0.31\u20130.67).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The incidence of LTFU among adults on ART in Guji zone was high, particularly during the first year of treatment. Male sex, younger age, lack of formal education, female sex work, and daily labor were associated with increased LTFU risk, while residing in the same woreda as the health facility and having documented phone numbers were protective. Targeted interventions including enhanced counseling for high-risk groups, community-based ART refill models, and active phone-based tracking systems should be implemented to improve retention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-13965-5","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T06:25:01Z","timestamp":1783578301000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and predictors of loss to follow-up among HIV infected adults on antiretroviral therapy in Guji Zone, Southern Ethiopia, 2023"],"prefix":"10.1186","volume":"26","author":[{"given":"Dereje","family":"Girma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemechis","family":"Tuke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zelalem","family":"Jebessa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kebebew","family":"Lemma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azmach","family":"Habtegiorgis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashenafi","family":"Lemesa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alo","family":"Edin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"13965_CR1","unstructured":"Jameson JL, editor. 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PLoS One. 2022;17(10):e0275954. https:\/\/doi.org\/10.1371\/journal.pone.0275954.","journal-title":"PLoS One"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-13965-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13965-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13965-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:59:53Z","timestamp":1784185193000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-13965-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["13965"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-13965-5","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"assertion":[{"value":"3 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical clearance for this study was obtained from the Institutional Review Board (IRB) of Bule Hora University Institute of Health (Reference Number: BHU\/IOH\/SPH\/092\/2015). All study methods and protocols were ethically approved by the IRB, ensuring that the research adhered to ethical standards and regulations, and was conducted in accordance with the Declaration of Helsinki. Permission for data extraction was granted by the relevant administrative authorities of the respective health facilities and all information utilized in this study was derived from anonymized data, thereby ensuring the confidentiality and privacy. Informed consent was not required as the study utilized secondary data.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1360"}}