Social, facility, and individual risk factors for poor retention in HIV care at adult HIV care and treatment clinics in Tanga and Kilimanjaro regions-Tanzania, 2017

  • Viral hepatitis and HIV
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Background:
Despite expansion of HIV services in Tanzania, retention in HIV care is inadequate. In 2016 approximately 30% of adults are lost to follow-up by 12 months. A case-control study was conducted at district level HIV Care and Treatment Clinics (CTC) in Northern, Tanzania to assess correlates of retention in care and inform programmatic response.
Methods:
Eligible participants were aged ≥18 years and enrolled at CTCs of high volume HIV treatment facilities in nine districts in Tanga and Kilimanjaro for ≥3 months by December 2016. Cases and controls were conveniently selected from clinic registers in 1:2 ratios (~30 clients per clinic) and matched on enrollment year. Cases were clients absent from CTC for ≥3 months. Controls had at least one visit in the last three months. An interview schedule was administered to collect socio-demographic, facility, and behavioral characteristics at participants’ residence (cases) and CTC (controls). Odds Ratios (OR) and 95% Confidence Intervals (95% CI) estimated associations between risk factors and case status.
Results:
There were 105 cases and 210 controls. Mean age was 40.8 (SD=11.9). Most participants were female 199 (63.2%), partnered 133 (42.2%), and working 248 (78.7%). All had initiated antiretroviral therapy and the median on ARV was two years ranging from 0.03 to 19 years. Cases were significantly more likely to report fear of disclosure of HIV status (OR 2.72, 95% CI 1.58-4.69). Cases were significantly less likely to be female (OR 0.60, 95% CI 0.37-0.98) or report being satisfied with care (OR 0.14, 95% CI 0.06–0.33).
Conclusion
Perceived stigma, male gender, and low-satisfaction with care are important risk factors for poor retention at CTCs in Northern Tanzania. Strategies to reduce stigma and engage male clients may improve retention in care. Further research is needed to understand and improve satisfaction with care at CTCs.

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