A Retrospective Cohort Analysis Investigating Determinants and Rates of Retention among Children and Adolescents Receiving Antiretroviral Therapy in Center and East Regions of Cameroon

2025 · doi:10.1101/2025.08.07.25333255
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This retrospective cohort study analyzed anonymized electronic medical records from 1,319 children and adolescents (0–15 years) initiating ART across 66 HIV treatment sites in Cameroon’s Center and East Regions, describing 2-year trends in retention in care and sociodemographic/clinical factors associated with retention. Retention declined over time, with rates at months 6, 12, 18, and 24 of 86.2%, 82.6%, 79.8%, and 77.2%, and after 24 months retention higher in the Center Region (83.1%) than the East Region (71.5%). In adjusted models, female participants had region-dependent differences in retention, and dolutegravir use and ART delivery through differentiated service delivery models were associated with reduced loss to follow-up risk; unexpectedly, children <5 years were less likely to be retained than adolescents 5–15 years, potentially due to local context. The paper is limited by reliance on retrospective record data, without prospective confirmation of causal mechanisms. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Background: Children and adolescents (0 – 15 years) living with HIV (ACLHIV) in low-resource settings face individual, household, and systemic challenges to engagement and retention in HIV care and antiretroviral treatment (ART) adherence. As a result, ACLHIV register poorer care and treatment outcomes. We describe care retention outcomes and factors that influence them among ACLHIV enrolled in ART in Cameroon. Methods: We explored trends in two-year follow-up and sociodemographic and clinical factors associated with retention in care among ACLHIV living in the Center and East Regions. We retrospectively analyzed anonymized medical records (n = 1,319) from a cohort of all ACLHIV initiating ART for a three-year period between October 1, 2019, to September 30, 2022. Data were obtained from electronic medical records from 66 HIV treatment sites. Trends in retention in care among ACLHIV on ART were described using Kaplan-Meier survival estimates. Cox proportional analysis was performed to identify factors associated with retention in care. Results: Retention in care among ACLHIV in both regions at months 6, 12, 18, and 24 was 86.2%, 82.6%, 79.8%, and 77.2%, respectively. After 24 months, retention was higher in the Center Region (83.1%) compared to the East Region (71.5%). In adjusted regression models, female ACLHIV were more likely to be retained in care in the Center Region but less likely in the East Region compared to boys after 24 months. Clinical treatment factors, such as current use of a dolutegravir and receipt of ART through differentiated service delivery models, were associated with a considerably reduced risk of loss to follow-up. Unexpectedly, we found that very young children (<5 years) were less likely to be retained in care than older adolescents (5-15 years), which could be partially explained by local context of care. Conclusion: This study suggests that Cameroon is lagging behind targets for HIV retention in care for ACLHIV. More effective and targeted clinical and social behavioral interventions are needed to address barriers to long term engagement in care by ACLHIV. Targeted research studies and improved data-driven, process monitoring is needed to determine other underlying factors that lead to sub-optimal care retention outcomes among this sub-population.
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Abstract

Background Children and adolescents (0 – 15 years) living with HIV (ACLHIV) in low-resource settings face individual, household, and systemic challenges to engagement and retention in HIV care and antiretroviral treatment (ART) adherence. As a result, ACLHIV register poorer care and treatment outcomes. We describe care retention outcomes and factors that influence them among ACLHIV enrolled in ART in Cameroon.

Methods

We explored trends in two-year follow-up and sociodemographic and clinical factors associated with retention in care among ACLHIV living in the Center and East Regions. We retrospectively analyzed anonymized medical records (n = 1,319) from a cohort of all ACLHIV initiating ART for a three-year period between October 1, 2019, to September 30, 2022. Data were obtained from electronic medical records from 66 HIV treatment sites. Trends in retention in care among ACLHIV on ART were described using Kaplan-Meier survival estimates. Cox proportional analysis was performed to identify factors associated with retention in care.

Results

Retention in care among ACLHIV in both regions at months 6, 12, 18, and 24 was 86.2%, 82.6%, 79.8%, and 77.2%, respectively. After 24 months, retention was higher in the Center Region (83.1%) compared to the East Region (71.5%). In adjusted regression models, female ACLHIV were more likely to be retained in care in the Center Region but less likely in the East Region compared to boys after 24 months. Clinical treatment factors, such as current use of a dolutegravir and receipt of ART through differentiated service delivery models, were associated with a considerably reduced risk of loss to follow-up. Unexpectedly, we found that very young children (<5 years) were less likely to be retained in care than older adolescents (5-15 years), which could be partially explained by local context of care.

Conclusion

This study suggests that Cameroon is lagging behind targets for HIV retention in care for ACLHIV. More effective and targeted clinical and social behavioral interventions are needed to address barriers to long term engagement in care by ACLHIV. Targeted research studies and improved data-driven, process monitoring is needed to determine other underlying factors that lead to sub-optimal care retention outcomes among this sub-population. Competing Interest Statement The authors have declared no competing interest. Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: -Clearance was granted by the Centers for Disease Control and Prevention (CDC), Georgetown University (GU), and the Comité National d’Ethique de la Recherche pour la Santé Humaine (CNERSH). -CDC: 0900f3eb81dbf249. GU: STUDY00004228. CNERSH: N/A (see attachment) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All relevant data are within the manuscript and its Supporting Information files.

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