Risk factors for Interruption in Treatment among HIV-infected adolescence attending health care and treatment clinics in Tanzania

Abstract

Background Interruption in Treatment (IIT) is a challenge in HIV care and treatment programs in sub- Saharan Africa. We analyzed risk factors for IIT among HIV-positive adolescence receiving care and treatment in Tanga region, Tanzania. The findings will help to guide the development of strategies targeting adolescents to improve retention of patients in care and treatment services. Methods We conducted retrospective longitudinal cohort study using secondary data of adolescent patients enrolled in care and treatment clinics in Tanga from October 2018 to December 2020. We defined Interuption in Treatment as missing clinic visits for 90 consecutive days after the last scheduled appointment date on anti-retroviral therapy (ART). Cox proportional hazard regression models were employed to identify risk factors of the outcome variable. Results Among 2,084 adolescents of age between 15 to 19 years were followed for two years, whereby 546 (26.2%) had interrupted treatment. The median age of the participants was 14.6 years (interquartile range, IQR: 12.6–16.6 years), with age between 15 to 19 years, male sex, with advanced HIV disease and were not on Dolutegravir (DTG) related regimens were associated with interruption in treatment; (Hazard ratio (HR) 1.43, 95% CI 1.23–1.66, p < 0.0001, HR 2.47, 95% CI 1.62–3.77, p < 0.0001, HR: 2.47, 95% CI 1.91– 3.21, p < 0.0001 and HR: 6.67, 95% CI 3.36– 7.04, p < 0.0001 respectively). Adolescents who were on ART for less or equal one year compared to those on ART for more than one year were protective toward interruption in treatment (HR: 0.68, 95% CI 0.54–0.87, p = 0.002). Conclusions The risk of interruption in treatment was high among adolescents in HIV care and treatment facilities in Tanga. This might lead to poor clinical outcomes, and increased drug resistance among ART-initiated adolescents. Placing more adolescents with DTG based drug, strengthening access to care and treatment and rapid tracking of patients is recommended to improve patient outcomes.