Losing their way: a cohort analysis of retention in care among adolescents on antiretroviral therapy in lusaka district, Zambia

Abstract

Background: Retention in antiretroviral therapy (ART) is crucial for adherence, viral suppression, and preventing drug resistance. Adolescents (10-19 years) face retention challenges, affecting progress toward 95% viral suppression. Data on retention for this specific age bracket remains limited in Zambia. Methods: A retrospective cohort analysis of 3978 adolescents on ART in Lusaka examined socio-demographic, clinical, treatment, and behavioral data. Kaplan–Meier estimates analyzed retention, and Cox regression identified associated factors using SPSS v29. Results: Seventy percent remained in care, while 30% had interruptions, transfers, or death. Females (57.1%) had a higher non-retention risk (aHR: 1.21 [1.08-1.36]). Retention was lower in older adolescents (15-19 years, aHR: 0.11 [0.10-0.13]). Retention increased with early ART initiation with those starting ART at 15 to 19 years showed lowest retention (aHR: 578.50 [421.00-794.91]). Not changing ART regimens decreased retention (aHR: 0.88 [0.77-0.99]). Conclusions: Targeted interventions should prioritize females, older adolescents, early ART initiation, and regimen changes.