Impact of COVID-19 on Care Seeking Behavior of Patients at Tertiary Care Chronic Follow-up Clinics in Ethiopia: A Cross-Sectional Telephone Survey.

Background: Health service delivery and the uptake of health services were greatly affected by COVID-19. The current study assessed the change in patients' care-seeking behavior after the first COVID-19 case was reported in Ethiopia. Methods: A cross-sectional survey was conducted among patients who were appointed at Tikur Anbessa Specialized Hospital (TASH), between mid-March to mid-June 2020. Data was collected through telephone, using a pre-tested, structured questionnaire. Data were analyzed using SPSS software version 25. Descriptive statistics and binary logistic regression models were used to describe the data and assess factors associated with loss to follow-up (LTFU). Results: Among 644 interviewed patients, 70% were lost to follow-up. Fear of COVID-19 infection (87.1%) and transportation problem due to lockdown (82.7%) were among the main reasons for loss to follow-up. Patients aged >= 60 years had highest odds of missing a follow-up in the multivariable logistic regression analysis. The odds of loss to follow up (LTFU) for the fear of COVID-19 was 13 times higher than among patients who did not have fear (AOR=13.39, 95% CI: 7.96-22.50). The odds of loss to follow up among patients who reported transportation problems were 3.6 times higher than among those who did not have transport problems (AOR=3.64, 95% CI: 1.93-6.88,). The odds of loss to follow up among patients with severe and very severe illness were about three times higher (AOR=2.7, 95% CI: 1.48-5.01). Conclusion: Patient's care-seeking behavior with chronic medical conditions at the chronic care clinics of TASH were seriously compromised during COVID-19. Patient's age (>60 years), chronic disease severity, fear of COVID 19 and transportation problems significantly predicted LTFU. Strategies such as task shifting and establishment of telemedicine services should be explored to meet the ongoing health needs of chronically ill patients on established follow up care.