Predictors of Attrition from Care and Treatment Centres among HIV-positive Pregnant and Breastfeeding Adult Women in Dar es Salaam, Tanzania

Abstract

In Tanzania, poor retention rates among pregnant and breastfeeding mothers continue to be a problem, contributing to a mother-to-child HIV transmission rate of 11% in 2019, compared to a global target of 5%. The goal of this study was to determine the influence of retention on clinical outcomes and identifying predictors of attrition among HIV-positive pregnant and breastfeeding women from follow-up care in Dar es Salaam. A retrospective cohort study included HIV-positive women who engaged in PMTCT services in public and private health facilities between January 2016 and December 2019. Secondary data were extracted from databases used for routine follow-up in care and treatment clinics (CTCs). The estimates of cumulative incidences of poor retention from date of enrollment or ART initiation were assessed using Kaplan €“Meier method. The Cox regression model was used to identify the predictors of attrition. Among 20,225 HIV-infected pregnant and lactating women enrolled in PMTCT services, 93.35%, 89.07%, and 85.24% were classified as retained in care at 12, 24, and 36 months, respectively. The attrition rate at the end of the follow-up period was 15.82%, and WHO clinical stages 3 or 4 (aHR = 1.67, 95% CI: 1.46 €“1.89;  p-value < 0.001) and unsuppressed viral load (aHR = 3.79, 95% CI: 3.20 €“4.49;  p-value < 0.001) were predictors of increased risks of attrition. The maternal age group 25 €“34 years (aHR = 0.24, 95% CI: 0.18 €“0.32;  p-value < 0.001), being married or cohabiting (aHR = 0.45, 95% CI: 0.38 €“0.55;  p-value < 0.001), an efavirenz (EFV)-based regimen (aHR = 0.26, 95% CI: 0.19 €“0.35;  p-value < 0.001), and good adherence to ART (aHR = 0.61, 95% CI: 0.48 €“0.79;  p-value < 0.001) were factors associated with reduced risks of attrition. The study shows that a strong tracking system for lost to follow-up (LTFU), that is, patients who miss appointments to the same health facility for more than 3 months after the last scheduled clinical visit, should be prioritised for successive PMTCT programmes for better clinical outcomes.

Keywords:   Retention, Attrition, Treatment, Clinics, Loss-to-follow up