Browsing by Author "LoloSarah"

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    Factors Contributing to Retention in Care and Treatment Adherence Among People Living With HIV Returning to Care in South-Eastern Tanzania: A Qualitative Study
    (HIV/AIDS - Research and Palliative Care, 2025-02-25) Matimbwa, Hassan; LoloSarah; Matoy,Leila
    Globally, 84.2 million people have been infected with HIV/AIDS since the pandemic began more than three decades ago.1 According to the UNAIDS Global Report of 2023 currently 39 million people are living with HIV (PLHIV), while more than 40 million have died from HIV-related diseases.2 Sub-Saharan Africa remains the region hit hardest with 3.4% of adults living with HIV, accounting for approximately two-thirds of all cases globally.3 In Tanzania, one person with HIV lives in 11.8% of urban and 8.7% of rural households.4 The Tanzania HIV impact survey 2022–23 reported an HIV prevalence of 4.4% with 1,548,000 adult PLHIV, higher in women (5.6%) compared to men (3.0%).5 Of 1.5 million adult PLHIV in Tanzania, 82% know their status, 98% receive treatment, and 94% are virally suppressed.5 Antiretroviral therapy (ART) is the most effective strategy for the prevention and treatment of HIV. The use of ART has resulted in a significant decrease in HIV-associated comorbidities and risk of HIV-related death.6–8 In addition, proper use of ART improves HIV patients’ well-being, suppresses viral load, and reduces HIV transmission risk, thus serving as a key prevention strategy9,10 A significant challenge is patient attrition on ART, which increases the risk of adverse health outcomes and hinders global HIV control.10,11 Retention in care is critical to ensure ART adherence, viral suppression, and prevention of HIV drug resistance.12–14 Several associated factors influence PLHIV to remain in care, including clinical, sociocultural, economic, and health systems aspects, as well as geographical and other contextual factors.15,16 Other factors contribute to poor treatment adherence and care, including fear of side effects, alcohol and substance abuse, stigma, distance from the clinic, and poverty.6,14,17–20 Experiences from the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) show the complex care cascade in a rural setting in South-eastern Tanzania21,22 with periods with poor drug adherence contributing to poor treatment outcomes.23 Efforts to improve HIV treatment adherence such as training communication skills among healthcare providers as been shown to improve treatment outcomes.22 However, attrition to care remains a major challenge15 with a high loss to follow-up (LTFU) rate of 21%-41%, whereby half of LTFU participants return to care at a later time point.24 Patients returning to care are an important group, as we can learn from them the reasons for dropping out and returning to care, as well as reasons for interrupting drug intake.25,26 Knowing these factors allows for the design of effective interventions that can improve retention in care and drug adherence27 and can be addressed by qualitative research.28 Re-engagement programs successfully led to the return of patients lost to follow-up.29,30 The role of family or treatment supporters is to support PLHIV to adhere to treatment and retention in care through emotional, social, and practical support.31,32 In this study, we explored factors associated with dropping out from and returning to care, remaining in care, and treatment adherence among PLHIV, who returned to care after missing clinical visits for more than 3 months and with an irregular ART intake since the last clinical visit in South-eastern Tanzania. In addition, we interviewed participants’ treatment supporters and healthcare workers (HCWs) involved in their care.