Factors Contributing to Defaulting on Antiretroviral Therapy Among People Living with Hiv in Selected Health Facilities in Maswa District, Tanzania

Abstract

Background: Retention in antiretroviral therapy (ART) is essential for achieving viral suppression and improving health outcomes among people living with HIV (PLHIV). However, ART default remains a significant challenge, particularly in resource-limited settings such as Maswa District, Tanzania. This study aimed to identify the factors contributing to ART default among PLHIV attending selected healthcare facilities in the district. Methods: A cross-sectional study with a mixed-methods retrospective approach was conducted. Quantitative data were extracted from electronic medical records of 2,602 HIV-positive individuals who initiated ART between January 2020 and December 2022. Descriptive statistics and inferential statistics were conducted. Analysis, were conducted using SPSS version 25 to determine predictors of ART default. Qualitative data were collected through in-depth interviews (IDIs) with nine ART clients and key informant interviews (KIIs) with five healthcare providers. Thematic analysis was performed to explore barriers and enablers of ART retention. Results: The ART default rate was 22.8%. Quantitative analysis identified key predictors of default, including older age (above 35 years), marital status (divorced or separated, advanced disease stage at enrollment (WHO Stage 4), and unsuppressed HIV viral loads. Clients in these categories had significantly higher odds of discontinuing ART compared to their counterparts. Qualitative findings from IDIs revealed that stigma, lack of ART knowledge, financial constraints, and long distances to health facilities were major barriers to ART retention. KIIs with healthcare providers highlighted challenges such as inadequate staffing, high patient loads, and inconsistent follow-up mechanisms. However, both ART clients and healthcare providers emphasized that social support from family and community members, timely linkage to care, and integrated healthcare services were key facilitators of retention. Conclusion and Recommendations: Findings underscore the need for targeted interventions to improve ART retention. Strengthening patient education, implementing stigma-reduction programs, and integrating ART services into primary healthcare can enhance adherence. Healthcare providers should adopt individualized adherence support strategies, while policymakers should focus on system-wide improvements to streamline ART service delivery. Further research should explore long-term retention trends and evaluate the impact of tailored interventions to reduce ART default and improve treatment outcomes in Tanzania.