Assessing Retention in Care and Factors Associated With Antiretroviral Therapy Among People Living With HIV in the Upper West Region of Ghana: A Retrospective Cohort Study

Abstract

Background: Antiretroviral therapy (ART) programs that retain people living with HIV (PLWH) in care are essential for maintaining viral suppression, improving health outcomes, and halting the spread of HIV. While ART accessibility has improved, retention in care is still low in Ghana. Although several factors account for this, there are limited data to support it. Tis study assessed the factors infuencing retention in care of PLWH in the Upper West Region (UWR) of Ghana. Method: Te study used a retrospective cohort design to track 482 PLWH who started ART in 2019 across 14 ART clinics in the UWR of Ghana. Demographic, clinical, and psychological elements linked to retention were accessed by extracting data from the HIV electronic tracker database. Te characteristics of the study participants summarized using descriptive statistics, estimates of retention rates, and relationships between presumed predictors and retention were obtained through Cox proportional hazards regression and Kaplan–Meier survival analysis. Results: Te results demonstrate that 384/482 (79.7%) participants remained in care at 6 months, 354/482(73.4%) at 12 months, 298/482 (61.8%) at 24 months, and 260/482 (53.9%) at 36 months, indicating a decline in ART retention with time. Age, HIV status disclosure, and viral load suppression are important determinants of retention. Older ages between 50 and 79 years (HR = 0.29, 95% CI: 0.13–0.61) have a 71% reduced risk of attrition compared with younger age groups. Psychosocial factors were positively associated with retention as the HIV status disclosure had HR = 0.50 (95% CI: 0.29–0.88). Te unknown viral load status signifcantly increased the risk of attrition (HR = 6.41, 95% CI: 4.50–9.12). Conclusion: Tis study has demonstrated that retention rates decrease with time and that retention was signifcantly predicted by age and viral load status, with better retention rates shown in older PLWH and those aware of their viral load status.