The Challenge of Long-Term Retention in HIV Care for Vertical Transmission Prevention in African Countries
New data from Tanzania highlight the ongoing challenge of retaining pregnant women with HIV in long-term care programs aimed at preventing vertical transmission. The study, conducted by researchers from the Tanzanian non-profit organization Management and Development for Health, revealed that only 78% of pregnant women with HIV remained in the vertical transmission prevention program after the first year. By the sixth year, this number decreased further to 56%.
The study, which included over 22,000 participants across 226 public and private health facilities in Tanzania, identified several key findings:
1. The attrition rate for ART discontinuations was 13.8 per 100 person-years, with the majority due to loss to follow-up.
2. Over half of the discontinuations occurred within the first year, with 47% of women discontinuing after only one visit.
3. Factors contributing to attrition included age (with adolescents under 20 having a higher attrition rate), gestation age at enrollment, repeated pregnancies, time on ART, advanced HIV disease, and type of facility providing care.
4. The study also compared these findings with data from South Africa, highlighting similar challenges in vertical transmission prevention and the strong link between maternal viral load and transmission risk.
The findings underscore the critical need for improved retention strategies and enhanced support for pregnant women with HIV. Identifying at-risk mothers and providing comprehensive care, including timely initiation of ART and adherence support, is essential to reduce vertical transmission rates and improve outcomes for both mothers and infants.
