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.

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. This study assessed the factors influencing retention in care of PLWH in the Upper West Region (UWR) of Ghana. METHOD: The 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. The 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: The 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). The unknown viral load status significantly increased the risk of attrition (HR = 6.41, 95% CI: 4.50-9.12). CONCLUSION: This study has demonstrated that retention rates decrease with time and that retention was significantly predicted by age and viral load status, with better retention rates shown in older PLWH and those aware of their viral load status.