Abstract
Introduction
Globally, by the end of 2022, there were 39 million people living with HIV (PLHIV), 29.8 million of whom received antiretroviral therapy (ART), with approximately 63,000 deaths related to HIV. The main goals of HIV/AIDS care and treatment are to reduce morbidity and mortality and to improve the quality of life of PLHIV. Therefore, maximizing retention in care is critical to the long-term success of HIV management. However, the lack of retention in treatment remains a significant challenge to the global success of ART coverage. Cambodia has been a notable success in the fight against the HIV/AIDS epidemic and is moving toward elimination. Despite the success of HIV care and treatment, there is limited documentation on retention rates and their associated predictors.
Methods
A retrospective data analysis of 920 patients from 2014-2020 in Social Health clinic was performed via Stata V15. Our primary outcome of interest was retention in care after 12 months of ART initiation. The Kaplan-Meier analysis was used to examine the retention rate at different times. All demographic and clinical variables were put in univariate Cox proportional hazards regression analysis and multivariate analyses to identify factors associated with retention, and the results are presented as adjusted hazard ratios (aHRs).
Results
Among the 920 PLHIV, the retention rates for HIV/AIDS care and treatment were 87.0% at 12 months, 85% at 24 months, 75% at 48 months, and 70% at 84 months. Among these patients, 56.6% were female, and 45.9% were married. Most patients were over 15 years old (85.9%). Compared with 2014, fewer patients were enrolled throughout the year. Married patients (aHR = 0.33, 95% CI: 0.14–0.77) and divorced patients (aHR = 0.68, 95% CI: 0.27–1.68) were less likely to be retained compared to non-married group. There was no significant difference in retention for patients with baseline CD4 counts of 201-350 (aHR = 0.53, 95% CI: 0.26-1.09) and CD4 counts >350 (aHR = 0.56, 95% CI: 0.27-1.15) compared with the reference group (CD4 counts <200). Patients with advanced WHO clinical stage IV (aHR = 0.17, 95% CI: 0.04–0.72) were less likely to be retained in care.
Conclusion
The 12-month retention rate for HIV/AIDS care and treatment was 87.0%, decreasing to 70% at the 84-month follow-up. The key predictors of retention in care included the year of cART initiation, marital status, and advanced WHO stage IV. We recommend providing counseling services for married individuals and encouraging spouse involvement in healthcare visits and treatment to enhance the understanding of HIV management and the importance of ongoing care. Additionally, developing and implementing an integrated, interoperable patient tracking system across all ART sites is crucial for sharing real-time patient data and effectively tracking movement between sites.