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. 2025 Jul 1;25(1):852.
doi: 10.1186/s12879-025-11157-1.

Retrospective cohort study of predictors of loss to follow up among adolescents and young adults living with HIV on ART in Dar es Salaam, Tanzania, 2015-2019

Magreth Thadei Mwakilasa #  1   2 , Maryam Amour #  3 , Suleiman Chombo  4 , Joan Rugemalila  5 , Emmanuel Balandya  6 , Blandina T Mmbaga  7 , Lameck Machumi  8 , Angelica Rugarabamu  5 , Michael Johnson Mahande  8 , David Sando  8 , Bruno F Sunguya  3
Affiliations

Retrospective cohort study of predictors of loss to follow up among adolescents and young adults living with HIV on ART in Dar es Salaam, Tanzania, 2015-2019

Magreth Thadei Mwakilasa et al. BMC Infect Dis. .

Abstract

Background: In Tanzania, loss to follow-up (LTFU) among adolescents and young adults living with HIV (AYLHIV) presents a significant challenge. A retrospective cohort study analysing data found that approximately 42% of adolescents on antiretroviral therapy (ART) were LTFU between 2014 to 2016. This study examined the predictors of LTFU among AYLHIV in Dar es Salaam during their first year of ART treatment.

Methods: This retrospective cohort study utilized routine data collected in care and treatment centres among adolescents and young adults aged 10-24 years living with HIV in Dar es Salaam who were enrolled in HIV care from 2015-2019. The data were analysed using STATA 14. Descriptive statistics were summarized using frequencies and proportions. Kaplan-Meier method was used to determine failure probabilities within one year of ART initiation. The Fine and Gray test was conducted to report adjusted sub-hazard ratios (aSHRs) and cumulative incidence estimates for LTFU within one year of ART initiation, accounting for mortality as a competing risk.

Results: A total of 15,874 AYLHIVs enrolled in Care and Treatment Clinics between 2015 and 2019 were studied. The majority (10,913, 68.7%) were young adults, and 13,160 (84.4%) were female. The percentage of LTFUs within one year of ART initiation was 15%. The significant predictors of LTFU were age 20-24 years, having a CD4 cell count between 350 and 499, receiving care in healthcare facilities located in the Ubungo district and being enrolled in care between 2018 and 2019. Receiving care at private healthcare facilities, having a tuberculosis co-infection, and being classified as WHO Stage III were all associated with a reduced risk of LTFU in ART care.

Conclusion: This study found that adolescents and young people in Tanzania experience 15% rates of LTFU in ART care, within one year of ART initiation. Therefore, HIV service providers need to pay particular attention to the AYLHIV and factors that influence LTFU in ART care. The increasing incidence of LTFU necessitates the implementation of effective and friendly tracing interventions to identify AYLHIV patients who have become LTFU to re-engage them in care.

Keywords: Adolescents; HIV/AIDS; Loss to follow-up; Predictors; Tanzania; Young adult.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Muhimbili University of Health and Allied Sciences (MUHAS) Institutional Review Board (IRB) granted ethical approval for this study, with the reference number DA.282/298/01. The Management and Development for Health (MDH) provided permission to access the necessary data. Given the retrospective observational nature of the study and the anonymization of medical records, the MUHAS-IRB waived the requirement for individual patient informed consent. This decision was based on two factors: firstly, the study utilized anonymized, routinely collected secondary data from CTCs, eliminating the need for direct interaction with participants. Secondly, all data were extracted from the CTC database, ensuring that the authors involved in this study had no physical contact with participants or access to identifiable information during or after the data analysis process. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki, and all procedures involving human data adhered to these guidelines [49]. Consent for publication: Not applicable. Competing interest: I have read the journal's policy, and the author of this manuscript has the following competing interests. Prof. Emmanuel Balandya, a coauthor of this publication, held the position of Director of Research and Publication on the Institutional Review Board (IRB) at Muhimbili University of Health and Allied Sciences. Although Prof. Emmanuel Balandya did not take part in the review or approval process for the study mentioned in this manuscript and abstained from any discussions or decisions regarding it, his role as the acting director of research and publication at the university required him to sign the ultimate ethical approval document. This potential conflict of interest is disclosed to guarantee transparency in the study process. All other remaining authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curve showing one year loss to follow-up among AYLHIV on ART in Dar es Salaam, Tanzania
Fig. 2
Fig. 2
Kaplan–Meier survival curve showing one-year loss to follow-up by sex among AYLHIV on ART in Dar es Salaam, Tanzania
Fig. 3
Fig. 3
Kaplan–Meier survival curves showing one year loss to follow-up by age group among AYLHIV on ART in Dar es Salaam, Tanzania
Fig. 4
Fig. 4
Kaplan–Meier survival curves showing one year loss to follow-up by year of enrolment among AYLHIV on ART in Dar es Salaam, Tanzania
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References

    1. Lamb MR, Fayorsey R, Nuwagaba-Biribonwoha H, Viola V, Mutabazi V, Alwar T, et al. High attrition before and after ART initiation among youth (15–24 years of age) enrolled in HIV care. AIDS Lond Engl. 2014;28(4):559–68. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517438/. Cited 2022 Sep 1. - PMC - PubMed
    1. Muwanguzi M, Lugobe HM, Ssemwanga E, Lule AP, Atwiine E, Kirabira V, et al. Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda. BMC Public Health. 2021;21(1):1489. - PMC - PubMed
    1. Ojwang’ VO, Penner J, Blat C, Agot K, Bukusi EA, Cohen CR. Loss to follow-up among youth accessing outpatient HIV care and treatment services in Kisumu. Kenya AIDS Care. 2016;28(4):500–7. - PMC - PubMed
    1. Insight Start Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807. - PMC - PubMed
    1. Nachega JB, Hislop M, Nguyen H, Dowdy DW, Chaisson RE, Regensberg L, et al. Antiretroviral Therapy Adherence, Virologic and Immunologic Outcomes in Adolescents Compared With Adults in Southern Africa. JAIDS J Acquir Immune Defic Syndr . 2009;51(1):65. Available from: https://journals.lww.com/jaids/Fulltext/2009/05010/Antiretroviral_Therap.... Cited 2023 Jan 15. - PMC - PubMed

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