Trends of attrition from HIV care and its predictors among adolescent girls and young women with inconsistent viral load suppression results in Mainland Tanzania, 2016–2024

Adolescent Girls and Young Women (AGYW) in Tanzania Mainland are disproportionately affected by HIV. They are at high risk of attrition from HIV care, undermining efforts to achieve the UNAIDS 95-95-95 targets by 2030. AGYW with inconsistent viral load suppression are particularly vulnerable, leading to suboptimal treatment outcomes and continued transmission risks. This study aims to assess attrition in care and identify factors associated with persistent unsuppressed viral load after ART initiation among adolescent girls and young women in Tanzania Mainland from 2016 to 2024. This study utilized retrospective data from the National AIDS Control Programme (NACP) CTC database, covering the period from 2016 to 2024. Data were accessed for research purposes on 19/05/2025. Survival analysis techniques were employed to estimate attrition rates and identify predictors among AGYW with inconsistent viral load suppression results. The overall attrition rate was 11.8 per 1,000 person-years. Attrition was higher among AGYW aged 20-24 years (AHR: 1.58; 95% CI: 1.31-1.91; p < 0.001) compared to those aged 15-19 years, and among those residing in rural areas (AHR: 1.15; 95% CI: 1.05-1.26; p = 0.002). Participants with an initial viral load ≥1,000 cp/mL had an increased risk of attrition (AHR: 1.28; 95% CI: 1.16-1.42; p < 0.001), as did those attending public facilities (AHR: 1.79; 95% CI: 1.23-2.61; p = 0.002). Protective factors included second-line ART (AHR: 0.63; 95% CI: 0.55-0.73; p < 0.001), ART duration ≥4 years (AHR: 0.43; 95% CI: 0.29-0.64; p < 0.001), and residence in the Lake Zone (AHR: 0.64; 95% CI: 0.54-0.76; p < 0.001). Early attrition from HIV care is common among AGYW with inconsistent viral load suppression, particularly in the first year. Tailored interventions targeting at-risk groups-based on age, residence, ART regimen, and facility type are urgently needed to improve retention and treatment outcomes in this population.