Trends of attrition from HIV care and its predictors among Adolescent Girls and Young Women with inconsistent viral load suppression results in Mainland Tanzania, 2016–2024
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Background
Adolescent Girls and Young Women (AGYW) in Tanzania Mainland are disproportionately affected by HIV and are at high risk of attrition from HIV care, undermining efforts to achieve the UNAIDS 95-95-95 targets by 2030. AGYW with inconsistent viral load suppression are particularly vulnerable, leading to suboptimal treatment outcomes and continued transmission risks.
Methods
A retrospective cohort study was conducted using data from the national CTC2 database. Survival analysis techniques were employed to estimate attrition incidence rates and identify predictors among AGYW with inconsistent viral load suppression results over a five-year follow-up period.
Results
The overall incidence rate of attrition was 11.8 per 1,000 person-years. Higher attrition was observed among AGYW aged 20–24 years (AHR: 1.58) compared to those aged 15-19 years, those residing in rural areas (AHR: 1.15) compared to those residing on urban area, with initial viral load ≥1,000 cp/mL (AHR: 1.28) compared to those with viral load < 1000 cp/mL, and those attending public health facilities (AHR: 1.79) compared to private or FBO facilities. Protective factors included being on second-line ART (AHR: 0.63), longer ART duration ≥4 years (AHR: 0.43), and residence in the Lake Zone (AHR: 0.64).
Conclusion
Early attrition from HIV care is common among AGYW with inconsistent viral load suppression, particularly in the first year. Tailored interventions targeting at-risk groups—based on age, residence, ART regimen, and facility type are urgently needed to improve retention and treatment outcomes in this population.
