Abstract:

Background: Developing countries, including Tanzania, encounter significant challenges in maintaining Antiretroviral Therapy (ART) adherence among people living with Human Immunodificiency Virus(HIV). Adolescent Girls and Young Women (AGYW) face difficulties in accessing comprehensive HIV care and treatment. While studies have examined ART retention in the general population, theres a lack of focus on AGYW and the social factors affecting their retention on ART. Understanding social determinants is vital for tailoring interventions to achieve regional, national, and global HIV care goals.

Objectives: This study aimed to assess proportion of ART retention among AGYW and identify social factors influencing their ART retention in Mwanza City Council.

Methods: A retrospective hospital-based study was conducted at health centers and hospitals in Mwanza City Council to determine ART retention rates. Additionally, a cross-sectional design was used to explore social determinants. Data were collected from 385 AGYW, drawn from two cohorts (2019-2020 and 2021-2022) using stratified and random sampling techniques. An interviewer-administered questionnaire was used to gather primary data. Statistical Package for Social Sciences (SPSS) version 26 was employed for descriptive and statistical analysis. Interviews and medical chart data abstraction provided information on socio-demographics, clinical characteristics, and treatment outcomes. Chi-square tests and binary logistic regression were used for analysis, with a significance level of p < 0.05.

Results: The retrospective study revealed ART retention rates of 72.6% for the 2019-20 cohort, 81.5% for the 2021-22 cohort, and 78.3% overall, indicating a 21.7% dropout rate. The crosssectional analysis showed that AGYW retained on ART were associated with primary education and above [aOR=5.747 (95% CI=2.806-11.770; p-value<001)], both parents' involvement in parenting [aOR=2.803 (95% CI=1.131-6.951; p-value=0.026)], and high income levels [aOR=3.861 (95% CI=1.077-13.846; p-value=0.038)]. Factors contributing to dropout included being married and living together [aOR=0.044 (95% CI=0.003-0.581; p-value=0.018)] or living together with an unmarried partner [aOR=0.082 (95% CI=0.007-0.970; p-value=0.047)] and perceived stigma or highly perceived stigma [aOR=0.058 (95% CI=0.030-0.111; p-value<001)].

Conclusion: The study revealed fluctuations in retention rate between AGYW for different age and cohort. Retention was high in recent years than previous years in the cohorts. The study revealed high dropout from ART among AGYW with young age in recent cohort. On the other hand, the findings revealed significant positive influence of education, parenting of both parents and high income on ART retention. Also, the findings revealed significant negative influence of perceived stigma and being in marital relationships on ART retention. Other social factors such as employment, associative stigma, household head, household violence, age, community-based ART, health insurance, and source of income had no association with ART retention. Study is evidence that social factors determine extent of ART retention among AGYW variably. Therefore, social factors should be studied from time to time, defined and streamlined in intervention strategies for retaining AGYW to ART.