31 May 2024 – Six years after pregnancy, nearly half of Tanzanian women with HIV have dropped out of HIV care programs, posing a significant challenge for preventing vertical transmission. A study by Management and Development for Health revealed that among pregnant women who enrolled for vertical transmission prevention services, only 56% remained in the program after six years. This study highlights the critical need for improved retention strategies to ensure continued care for these women.
Key Findings
Retention Rates:
First Year: 78% remained in the program.
Sixth Year: Only 56% continued receiving HIV care.
Early Discontinuation:
Nearly 50% of women who discontinued in the first year did so after just one visit.
Younger women were more likely to drop out; only 36% of those under 20 remained in care by the sixth year.
Age-Related Attrition:
Women aged 20–29: 50% retention.
Women aged 30–39: 60% retention.
Women aged 40 and older: 67% retention.
HIV in Tanzania:
Approximately two million Tanzanians live with HIV, with 59% being women of reproductive age.
Despite ART reducing vertical transmission risk to below 5%, Tanzania’s rate remains high at 11%.
Program Overview:
Pregnant women diagnosed with HIV are enrolled in prevention services that include antenatal care, ART, and infant testing.
Peer mothers provide psychosocial support, reminders for clinic appointments, and infant testing dates.
Women are transferred to general HIV clinics after two years or sooner if their infants are diagnosed with HIV.
Study Details
Participants: 22,631 women from 226 health facilities in Dar es Salaam.
Duration: Enrolled between 2015 and 2017, followed for up to six years.
Median Age at Enrollment: 30 years.
Marital Status: 52% married or cohabiting.
Enrollment Timing: 82% enrolled in the second or third trimester.
Prior HIV Diagnosis: 37% diagnosed before enrollment.
Attrition and Predictors
Overall Attrition Rate: 13.8 per 100 person-years.
First-Year Attrition: 57% of discontinuations occurred in the first year, with a rate of 27.1 per 100 person-years.
Predictors:
Age: Adolescents under 20 had a 63% higher attrition rate.
Gestation Age at Enrollment: Higher retention in earlier trimesters.
Repeated Pregnancy: Lower attrition rate.
Time on ART: Longer ART duration before pregnancy led to lower attrition.
Advanced HIV Disease: Slightly lower attrition rate.
Facility Type: Lower attrition in higher-level health centers.
Recommendations
To reduce high attrition rates and improve maternal and infant health outcomes, the study suggests:
Enhanced support for young mothers and those at high risk.
Improved access to care and adherence support.
Focus on maintaining viral suppression during and after pregnancy.
This study underscores the urgent need to address the barriers to long-term HIV care for postpartum women in Tanzania to prevent vertical transmission and ensure better health outcomes for mothers and their children.
