Factors Influencing Retention in Care among Adolescents and Young Adults Living with HIV Attending ART Clinic in Kogi State, Nigeria: A Quantitative Study

Factors Influencing Retention in Care among Adolescents and Young Adults Living with HIV Attending ART Clinic in Kogi State, Nigeria: A Quantitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Influencing Retention in Care among Adolescents and Young Adults Living with HIV Attending ART Clinic in Kogi State, Nigeria: A Quantitative Study Moses Luke, Ifedola Faramade, Adeoye Ojo, Jacob Ojedokun, Funke Adesina This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6381509/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background: Retention in care remains an effective parameter to manage antiretroviral therapy (ART) uptake for adolescents and young adults living with HIV/AIDS around us. Adherence to ART treatments is significantly challenging in many ART treatment centres where Nigeria's budget for sustainable healthcare is limited. This study examines the factors that influence retention in care among adolescents and young adults living with HIV attending ART clinics in Kogi State, Nigeria, as insights to enhancing long-term engagement in HIV treatment. Method: The study employed a descriptive cross-sectional design using a multistage sampling technique to select 307 adolescent and young adult participants enrolled on ART from all the treatment centres in three senatorial districts in Kogi State. A structured, self-developed questionnaire was used to collect the study data for bivariate and multivariate analysis using IBM SPSS version 26. Results: The study found that over half (52.1%) of respondents were adolescents in the age bracket 15–19 years, of which nearly two-thirds (58.6%) were female gender. Most (80.5%) of the youngsters had been initiated on the ART for nearly four years. The study revealed that a challenge in ART retention in care was significantly associated with incessant stigmatisation and discrimination (χ² = 28.45, p < 0.01). The study also revealed that lack of interest in ART was 0.030 more likely to influence adolescent and young adults' retention in care (β = -3.507, OR = 0.030, p < 0.001). Conclusion: Critical challenges faced by adolescents and young adults to remain in care were greatly influenced by increased stigmatisation and discrimination, among other factors. Addressing these barriers can be promoted through a stigma reduction initiative approach and flexible clinic schedules for HIV-infected young adults and adolescents. HIV/AIDS Adolescents Young Adults Retention in Care Kogi State Figures Figure 1 Figure 2 Introduction HIV/AIDS continues to be a formidable global health challenge, with adolescents disproportionately affected. Globally, approximately 2.1 million adolescents aged 10–19 were living with HIV in 2016, making up 6% of all HIV-positive individuals (UNICEF, 2017 ). Despite significant advances in treatment that have saved millions of lives, the epidemic still disrupts families and communities worldwide, particularly in sub-Saharan Africa where the burden is heaviest. UNAIDS (2018) reports that most new infections occur in this region, largely due to prevalent mother-to-child transmission and unprotected heterosexual intercourse, which remains responsible for about 80% of infections. Sub-Saharan Africa carries the highest HIV burden, with 1.7 million adolescents living with HIV. South Africa alone accounts for 25% of the region's 24.7 million HIV cases (UNAIDS, 2014; WHO, 2014). A report revealed that South Africa recorded over 400,000 new infections in 2012, the highest worldwide (Shisana et al., 2014 ). Among children aged 0–14, sub-Saharan Africa had nearly 3 million who were HIV-positive, along with 2.9 million young people aged 15–24 (WHO, 2011). Studies have shown that adolescent girls face higher risks, with an HIV prevalence of 5.6%, five times greater than that of boys (UNAIDS, 2014; 2018; UNICEF, 2014; 2017 ; Development, 2019 ; WHO, 2013). Two-thirds of all new adolescent infections globally occur in females, a disparity that was particularly severe in sub-Saharan Africa, where young women are two to three times more likely to contract HIV than males (UNICEF, 2017 ). Nigeria, which recorded its first HIV case in 1986, remains one of the most affected countries in the region. Despite an adult prevalence of 2.8%, Nigeria's large population results in about 3.1 million HIV cases, with a significant proportion of new infections occurring in West and Central Africa (PEPFAR, 2019 ; UNAIDS, 2017). About, 40% of Nigerians living with HIV are unaware of their status, largely due to limited access to treatment and prevention services (NAIIS, 2018 ). In Nigeria, as in other African nations, unprotected heterosexual intercourse is the dominant mode of transmission, compounded by socio-economic challenges and high-risk behaviors among key populations. Antiretroviral therapy (ART) plays a crucial role in suppressing the virus, restoring immune function, and reducing mortality (Nachega et al., 2009 ). However, treatment success relies heavily on retention in care and adherence, which are particularly challenging among adolescents due to factors such as risky sexual behavior, poor nutrition, and substance use (Kim et al., 2014 ). Although progress has been made, adolescents in sub-Saharan Africa continue to face disproportionate challenges in staying engaged with HIV care programs. To address these issues, this study seeks to examine the factors influencing retention in care among adolescents and young adults receiving ART in Kogi State, Nigeria. However, to mitigate the negative impact on this vulnerable population as efforts to combat HIV diseases among youngsters, this study seeks to examine the factors influencing retention in care among adolescents and young adults living with HIV who are receiving antiretroviral therapy (ART). By integrating global perspectives with local data, the study aims to provide evidence-based insights that can enhance ART adherence and promote long-term engagement in HIV care, ultimately contributing to improved health outcomes for this vulnerable population. Methods Study design, settings and sample size estimation The study employed a descriptive cross-sectional design using a multistage sampling technique to select 307 adolescent and young adult participants enrolled on ART of all the treatment centres in three senatorial districts in Kogi State. A structured questionnaire was used to collect the study data for bivariate and multivariate analysis using IBM SPSS version 26.0. The focused eligible respondents for this study were HIV-infected adolescents and young adults aged 10–24 who had been initiated and enrolled in the antiretroviral therapy (ART) HIV treatment program in Kogi State, Nigeria. The inclusion criteria also include individuals currently in HIV care, ART treatment defaulters, and those classified as lost to follow-up were considered for the study. This approach ensured a comprehensive understanding of the link between adherence and retention to ART. The multistage sampling comprised three sequential stages where Kogi State was divided into three strata (Kogi West, Kogi Central, and Kogi East). In each stratum, a random selection of one healthcare facility providing comprehensive ART services by balloting, while the final stage involved selecting the last sample in the study. The total sample size for this study was determined using N = Z 2 Pq (Susan Rose, Nigel Spinks, & Ana Isabel Canhoto, 2015) d 2 Where n = sample size Z = Standard normal deviate at confidence interval of 95% = 1.96 P = Retention Prevalence Rate (RPR) among Adolescent and Young Adults in Kogi state = 23.9% (NAIIS, 2018 ) q = 1 – P (1- 0.239 = 0.761) d = desired precision at 5% Therefore, N = 279 Adjusting for envisaged 10% non-response N = \(\:{\left(\frac{10}{100}\text{x}\:\:279\right)+\:\:279}^{.}\) N = 307 A total of 307 questionnaires were administered to respondents. Ethical consideration The Kogi State Ministry of Health's Ethical Research Committee granted ethical approval for the study ensuring compliance with ethical guidelines for research involving human participants. Prior to data collection, informed consent was obtained from all participants, emphasising their right to voluntary participation and discontinuing if they wish to. Respondents were fully informed about the study's objectives, and respondents' confidentiality was maintained. There was no potential risk whatsoever or danger to the participants. Statistical analysis A structured, self-developed questionnaire ( see Appendix I ) was used to collect the study data for descriptive, bivariate and multivariate analysis using IBM SPSS version 26. Descriptive statistics, including absolute frequencies, percentages, and bar chart were used to summarize the demographic characteristics of adolescents and young adults living with HIV, as well as their responses to questions on factors influencing retention in care. The bivariate analysis used chi-square statistic, and the multivariate analysis employed the logistic regression model to assess factors influencing retention in care using the odd ratio. Statistical significance was considered at p < 0.05. Results Socio-Demographic Characteristics of Respondents Table 1 shows the socio-demographic profile of adolescents and young adults on antiretroviral therapy (ART) in Kogi State. The most common age group among respondents was 15–19 (52.1%), followed by aged 20–24 (35.2%), while the least represented age group was 10–14 (12.7%). Over half (58.6%) of respondents were female, compared to their male counterparts (41.4%). Most respondents (85.7%) were single, while 14.3% were married. Regarding the respondents' educational attainment, nearly half (49.5%) had secondary education, while 23.8% had post-secondary education. A smaller proportion (6.8%) had primary education, while 19.9% had no formal education. Respondents' religious affiliation revealed a slightly higher proportion of Muslims (53.1%) than Christians (46.9%). Most of the respondents were Ebira (32.2%) indigenes and Igala (31.9%), followed by Yoruba indigenes (25%). Nearly two-thirds (59.6%) of respondents were students, slightly over one-tenth (13.7%) were gainfully employed, and 15.3% were either unemployed or actively seeking employment. Table 1 Socio-demographic characteristics of the respondents Variables Frequency n = 307 Percentage (%) Gender Male 127 41.4 Female 180 58.6 Age (years) 10–14 39 12.7 15–19 160 52.1 20–24 108 35.2 Marital status Single 263 85.7 Married 44 14.3 Highest level of education No formal education 61 19.9 Primary 21 6.8 Secondary 152 49.5 Post-Secondary 73 23.8 Religion Christianity 144 46.9 Islam 163 53.1 Ethnicity Yoruba 77 25.1 Ebira 99 32.2 Igala 98 31.9 Others 33 10.7 Occupational Status Unemployed 47 15.3 Employed 42 13.7 Schooling 183 59.6 Others 35 11.4 Respondents Duration of Antiretroviral Therapy (ART) Treatment and Co-morbidity Figure 1 shows that the majority (80.5%) of participants had been on ART for four years, while 17.9% had been receiving ART for 5–9 years, and a small fraction (1.6%) had been on treatment for over 10 years. Regarding spousal and family awareness of HIV status, 29.6% of respondents were aware that their spouse, child, or relative was also on ART, while 43.6% were unaware of their relative's HIV status. Similarly, 45.9% of respondents disclosed their HIV status to their spouse or family, while 32.2% had not disclosed their status. Exploring co-infection with other chronic illnesses, Fig. 2 shows that 17.6% of respondents had been diagnosed with Hepatitis B Virus (HBV) or Tuberculosis (TB). More than half (52.1%) of the respondents reported no chronic illness, while 30.3% were unaware of their co-morbidity status at the time of the study. Most respondents (81.1%) expressed willingness to take additional opportunistic infection (OI) medications to improve their health, whereas 10.7% declined, citing concerns over pill burden. Respondents' Experience of Quality of Care at ART Treatment Centres The study also assessed the perceived quality of care at ART centres. Most respondents (69.4%) felt respected and well-treated at their ART clinics, compared to one-fifth (20.5%) who felt otherwise. Regarding waiting times at healthcare facilities, 60.9% of respondents spent less than an hour during clinic visits, one-fifth (20.2%) spent 1–2 hours, and 18.9% reported waiting for two or more hours. Respondents reported stock-outs of ARV medication, whereas over one-quarter (27.7%) reported experiencing ARV shortages at the ART centres. On the contrary, 30.0% reported having ART medications when due without ART stock-outs. Also, the cost analysis of HIV-related services revealed that 39.1% of respondents never paid for HIV services, such as receiving ART drug regimens and condoms, among other services, while a very minimal proportion (3.6%) of respondents allegedly made payments for ART services. Considering the ART patients' satisfaction with the ART services in the study location, less than half (41.4%) of respondents rated the ART services excellently, and 26.7% considered the ART service to be good. However, 31.9% of respondents rated the services as very poor. Interestingly, when asked about continuity of care, more than half (52.1%) of respondents would like to switch to a different ART centre, compared with 37.5% who preferred to continue receiving treatment at their current healthcare facility. Factors Influencing Retention in Care among Respondents The study identified several key factors affecting retention among adolescents and young adults on ART in the study area. Nearly half (46.4%) of respondents opined that discrimination and stigmatisation are significant barriers to continued ART treatment. Transportation challenges accounted for 29.5%, and the distance to ART centres (3.6%) was also highlighted as an obstacle to retention in ART. Additionally, lack of trust in healthcare providers and time constraints accounted for 1.1%. The concerns for patient confidentiality were evident, with 7.2% of participants indicating that unauthorised disclosure of their HIV status by healthcare workers discouraged adherence to ART. The breach of confidentiality (3.2%) contributed to a lack of interest in ART, just as reported by the respondents. Other notable factors identified by the respondents were clinic appointments (2.9%) and the lack of attention and motivation after enrollment (5.0%). Table 2 shows a bivariate analysis of factors determining participant retention in care. Among the key factors influencing ART retention, discrimination and stigmatisation were statistically significant, with retention in care (χ² = 28.45, p < 0.001). There was a significant association between time constraints and retention care (χ² = 12.63, p = 0.001). Also, lack of interest in ARVs was statistically significant with respondents' retention in care (χ² = 16.29, p < 0.001). Conversely, several factors did not show a significant relationship with retention in care. These include transportation difficulties (χ² = 3.21, p = 0.073), disclosure of HIV status by healthcare workers (χ² = 0.76, p = 0.384), frequency of clinic appointments (χ² = 1.98, p = 0.159), and lack of confidence in healthcare workers (χ² = 0.45, p = 0.502) were not statistically significant. Table 2 Bivariate analysis of factors that determine retention in care among participants Factors Chi-Square Value (χ²) Degrees of Freedom (df) P-value Discrimination and Stigmatization 28.45 1 0.000* Transportation Problems 3.21 1 0.073 Disclosure of HIV Status by Health Workers 0.76 1 0.384 Frequency of Clinic Appointments 1.98 1 0.159 Time Constraints 12.63 1 0.001* Lack of Confidence in Healthcare Workers 0.45 1 0.502 Lack of Interest in ARVs 16.29 1 0.000* Multivariate Analysis of Logistic Regression Model of Factors Influencing Retention in Care The logistic regression analysis evaluates the factors influencing retention in care among vulnerable adolescents and young adults on ART. In Table 3 , the results highlight key predictors of retention, with odds ratios (OR) indicating the likelihood of how more predictive factors influence the dependent variable retention in care. Discrimination and stigmatisation were found to have a significant relationship with respondents' retention in care (β = -3.404, OR = 0.033, p < 0.05). Stigma-related experiences by respondents were 0.033 more likely to influence retention in care. Time constraint was significantly associated with respondents' retention in care (β = -3.507, OR = 0.030, p < 0.05). Time constraint was 0.030 more likely to influence ART care retention. Another critical factor was a lack of interest in ARVs (β = -3.507, OR = 0.030, p < 0.05), which was significantly associated with retention in care. Respondents' lack of interest was 0.030 more likely to influence retention in care. In contrast, transportation challenges were not statistically significant with respondents' retention in care (β = -0.720, OR = 0.487, p > 0.05). Other factors, such as disclosure of HIV status by healthcare workers (β = -24.016, OR = 0.000, p > 0.05), lack of confidence in healthcare workers (β = -24.016, OR = 0.000, p > 0.05) and frequency of clinic appointments (β = -24.016, OR = 0.000, p > 0.05), were not significantly predictors of retention in care. *Significant level: p < 0.05 Table 3 Logistic Regression model of factors associated with retention among the participants Dependent Variable Beta Coefficient Standard Error Wald Statistics df P-value Odd Ratio (OR) Constant 163.558 57312.97 0.000 1 0.998 1.078 Transportation problem. -0.720 0.691 1.085 1 0.298 0.487 Discrimination and stigmatization. -3.404 0.622 29.925 1 0.000* 0.033 Disclosure of clients’ status to others by health workers. -24.016 8987.38 0.000 1 0.998 0.000 Frequency of clinic appointment. -24.016 14210.32 0.000 1 0.999 0.000 Time constraints. -3.507 1.361 6.635 1 0.010* 0.030 Lack of confidence in health care workers. -24.016 23205.28 0.000 1 0.999 0.000 Lack of interest in ARVs -3.507 0.924 14.409 1 0.000* 0.030 *Significant level: p < 0.05 Discussion This study identified stigma and discrimination, time constraints, and lack of interest in ART as significant barriers to retention in ART care among adolescents and young adults in Kogi State, Nigeria. While these factors echo findings from previous research (Clouse et al., 2013 ; Kim et al., 2014 ), it is important to consider potential confounders. For instance, socioeconomic status and educational attainment could influence both an individual's experience of stigma and their ability to remain in care (Mofenson & Cotton, 2013 ). Other studies, such as those by Alonge et al. ( 2018 ) and Nachega et al. ( 2009 ), have noted that factors like baseline health status and mental health challenges also play a crucial role in ART adherence. Moreover, variations in the quality and accessibility of healthcare services across different ART treatment centres may independently impact retention outcomes. Clinic-level factors, such as staff competence, appointment scheduling, and the availability of support services, have been shown to influence adherence in resource-limited settings (Bateganya et al., 2018 ). In this context, the integration of decentralized ART services, such as mobile clinics, could mitigate the negative impact of these confounders by improving accessibility and service quality. In addition, healthcare accessibility, including the quality of services at different clinics, may confound the relationship between these barriers and retention outcomes. For example, research by Mukherjee et al. (2019) in similar resource-limited settings indicates that facility-level factors, such as staff attitudes and clinic organization, significantly affect retention rates. Differences in service delivery across regions could obscure the direct effects of individual-level barriers like stigma or treatment fatigue. The study found that time constraints significantly influence ART retention. This finding is consistent with findings from a study in South Africa by Nachega et al. ( 2009 ) that clinic schedules and long waiting times discouraged adolescent ART adherence. Similarly, a study in Nigeria by PEPFAR ( 2019 ) indicated that young people often miss appointments due to academic commitments, work obligations, and family responsibilities. Innovative approaches such as flexible clinic hours, weekend ART clinics, and telemedicine-based consultations may be employed to tackle rigid clinic times and long waiting times. The study found that lack of motivation and interest in ART was a major predictor of non-retention. This study aligns with findings by Jaspan et al. ( 2009 ) that treatment fatigue was prevalent among adolescents and young adults, particularly those who had been on ART since childhood. Also, Msemburi et al. ( 2016 ) found that some young adults in South Africa discontinued treatment after achieving temporary viral suppression, mistakenly believing they were cured. To avoid ART discontinuation, targeted psychosocial interventions and counselling in youth-friendly ART services are essential to sustain long-term engagement in HIV care. This study revealed that transportation difficulties have nothing to do with retention in care for vulnerable adolescents and young adults; comparatively, other studies in sub-Saharan Africa have reported varying influences of logistical factors on ART retention. While our study found that transportation challenges and frequency of clinic visits were not statistically significant predictors of retention, research in Kenya and Zimbabwe has highlighted transportation barriers as critical to care engagement (Asiki et al., 2017; Takarinda et al., 2017). This discrepancy suggests that regional differences in healthcare infrastructure and community support systems can markedly influence retention outcomes. In settings where transportation remains a major challenge, the impact on retention may be more pronounced than in regions with better accessibility. UNAIDS (2018) reported that in rural sub-Saharan Africa, adolescents often travel long distances to access ART, contributing to high default rates. This study suggests that healthcare accessibility in Kogi State may be helpful, and expanding decentralised ART services into integrating mobile ART clinics may further improve treatment access and adherence. Additionally, the study found no significant association between HIV status disclosure by healthcare workers and retention. This is in contrast with findings from some other contexts, where breaches in confidentiality have been shown to discourage adherence (Shisana et al., 2014 ). This divergence may stem from differences in local practices, data collection methods, or even cultural norms regarding privacy and stigma. A recent review by Mukherjee et al. (2019) emphasized that multifaceted interventions addressing both individual psychosocial factors and system-level barriers are crucial for improving retention rates. In this regard, the integration of flexible clinic schedules, mobile ART services, and robust psychosocial support mechanisms could mitigate some of the confounding factors influencing ART retention. Future research should incorporate these potential confounders through multivariable analyses and consider mixed methods approaches. Qualitative data could provide deeper insights into how factors such as socioeconomic status, mental health, and facility-level attributes interact with personal barriers to influence retention in ART care. Such an integrated approach would allow for a more nuanced understanding of ART adherence challenges, ultimately informing the design of targeted interventions that address both individual and systemic issues. Study limitations This study focused specifically on identifying the factors influencing ART retention among people living with HIV (PLHIV) in Kogi State. However, a key limitation was that the research was restricted to adolescents and young adults of the specified age, excluding other vulnerable age groups. Thus, results, perspectives and experiences of the broader HIV-positive population in the state were not captured, limiting the broader view of the findings. A qualitative study can be employed to gain a more comprehensive understanding of ART retention dynamics and conduct an in-depth analysis of the critical influencing factors on retention in care. Conclusion This study provides critical insights into the factors influencing ART retention among adolescents and young adults in Kogi State, Nigeria. The critical challenge faced by adolescents and young adults to remain in care was greatly influenced by increased stigmatisation and discrimination, among other factors. Addressing these barriers can be promoted through a stigma reduction initiative approach and flexible clinic schedules for HIV-infected young adults and adolescents. Declarations Ethics approval and consent to participate This study received ethical approval from the Health Research Ethics Committee of Kogi State Ministry of Health, Lokoja ( Ref: MOH/PRS/761/019 ). Informed consent to participate was obtained from all participants, as well as from the parents or caregivers of those under the age of 16. This study was performed following the Helsinki Declaration of 2013. Consent for publication Not applicable. Availability of data The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interest The authors declare no competing interests Funding The authors received no financial support for the research, authorship, and/or publication of this article. Author details 1 Family Health International (fhi360), Yola, Adamawa, Nigeria. 2 Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria. 3 Osun State University, Osogbo, Osun, Nigeria 4 Shared Approach Ltd. London, United Kingdom. 5 AIDS Healthcare Foundation, Lafia, Nasarawa, Nigeria. 6 Universidade Estadual De Campus, Sao Paulo, Brazil. References Alonge O, Babalola S, Uzochukwu B, Kieny MP. The impact of health system factors on retention in HIV care in Nigeria. BMC Health Serv Res. 2018;18(1):280. https://doi.org/10.1186/s12913-018-3163-4 . Bateganya M, Atuyambe L, Kambugu A, Ochen E. Enhancing retention in HIV care: The role of community support. Afr J AIDS Res. 2018;17(4):341–8. https://doi.org/10.2989/16085906.2018.1483499 . Clouse K, Pettifor AE, Maskew M, Bassett J, Van Rie A, Behets F, Gay C, Sanne I, Fox MP. Patient retention from HIV diagnosis through one year on antiretroviral therapy at a primary healthcare clinic in Johannesburg, South Africa. J Acquir Immune Defic Syndr. 2013;62(2):39–46. https://doi.org/10.1097/QAI.0b013e318273ac48 . Development S. (2019). Federal Republic of Nigeria National Youth Policy. Jaspan HB, Li R, Johnson L, Bekker LG. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6381509","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457575686,"identity":"14ad698f-d1dc-44c7-9043-329cbc1ebefd","order_by":0,"name":"Moses Luke","email":"data:image/png;base64,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","orcid":"","institution":"Family Heath International (fhi360), Yola, Adamawa","correspondingAuthor":true,"prefix":"","firstName":"Moses","middleName":"","lastName":"Luke","suffix":""},{"id":457575687,"identity":"d30194a7-5165-419c-b77c-1e377fa17186","order_by":1,"name":"Ifedola Faramade","email":"","orcid":"","institution":"Osun State University, Osogbo, Osun","correspondingAuthor":false,"prefix":"","firstName":"Ifedola","middleName":"","lastName":"Faramade","suffix":""},{"id":457575688,"identity":"2919e369-8437-481b-82a2-76c8c5bdc02f","order_by":2,"name":"Adeoye Ojo","email":"","orcid":"","institution":"Shared Approach Ltd. London","correspondingAuthor":false,"prefix":"","firstName":"Adeoye","middleName":"","lastName":"Ojo","suffix":""},{"id":457575689,"identity":"7c47822d-9a27-465d-a6f5-63507ccc2e36","order_by":3,"name":"Jacob Ojedokun","email":"","orcid":"","institution":"AIDS Healthcare Foundation, Lafia, Nasarawa","correspondingAuthor":false,"prefix":"","firstName":"Jacob","middleName":"","lastName":"Ojedokun","suffix":""},{"id":457575690,"identity":"3304168f-931a-4d90-b057-2cb343e17bd0","order_by":4,"name":"Funke Adesina","email":"","orcid":"","institution":"Universidade Estadual De Campus, Sao Paulo","correspondingAuthor":false,"prefix":"","firstName":"Funke","middleName":"","lastName":"Adesina","suffix":""}],"badges":[],"createdAt":"2025-04-05 10:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6381509/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6381509/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83127570,"identity":"0dc405d7-d2f1-4dc4-b6a2-11f57d2ad24f","added_by":"auto","created_at":"2025-05-20 09:53:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47465,"visible":true,"origin":"","legend":"\u003cp\u003eThe chart displays respondents ART duration\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6381509/v1/b27af9c88e56d77045a40815.png"},{"id":83127558,"identity":"b9d8eda7-99c7-424f-97aa-e868933fa08e","added_by":"auto","created_at":"2025-05-20 09:53:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38923,"visible":true,"origin":"","legend":"\u003cp\u003eThe chart illustrates the prevalence of other chronic illnesses among respondents\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6381509/v1/6c9bcf6ffcf622230dfceda3.png"},{"id":83128997,"identity":"26322900-857a-401a-8fef-772e2c9aa420","added_by":"auto","created_at":"2025-05-20 10:01:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1019947,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6381509/v1/6e3daff3-983e-4aa5-bc6a-f68555ab2add.pdf"},{"id":83127557,"identity":"dd698f35-5de3-425c-bca0-8f5216709414","added_by":"auto","created_at":"2025-05-20 09:53:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":159979,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIXIQUESTIONNAIRE.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6381509/v1/86925371de7a5660ba6cad8d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Influencing Retention in Care among Adolescents and Young Adults Living with HIV Attending ART Clinic in Kogi State, Nigeria: A Quantitative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHIV/AIDS continues to be a formidable global health challenge, with adolescents disproportionately affected. Globally, approximately 2.1\u0026nbsp;million adolescents aged 10\u0026ndash;19 were living with HIV in 2016, making up 6% of all HIV-positive individuals (UNICEF, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Despite significant advances in treatment that have saved millions of lives, the epidemic still disrupts families and communities worldwide, particularly in sub-Saharan Africa where the burden is heaviest. UNAIDS (2018) reports that most new infections occur in this region, largely due to prevalent mother-to-child transmission and unprotected heterosexual intercourse, which remains responsible for about 80% of infections.\u003c/p\u003e \u003cp\u003eSub-Saharan Africa carries the highest HIV burden, with 1.7\u0026nbsp;million adolescents living with HIV. South Africa alone accounts for 25% of the region's 24.7\u0026nbsp;million HIV cases (UNAIDS, 2014; WHO, 2014). A report revealed that South Africa recorded over 400,000 new infections in 2012, the highest worldwide (Shisana et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Among children aged 0\u0026ndash;14, sub-Saharan Africa had nearly 3\u0026nbsp;million who were HIV-positive, along with 2.9\u0026nbsp;million young people aged 15\u0026ndash;24 (WHO, 2011). Studies have shown that adolescent girls face higher risks, with an HIV prevalence of 5.6%, five times greater than that of boys (UNAIDS, 2014; 2018; UNICEF, 2014; \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Development, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; WHO, 2013). Two-thirds of all new adolescent infections globally occur in females, a disparity that was particularly severe in sub-Saharan Africa, where young women are two to three times more likely to contract HIV than males (UNICEF, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNigeria, which recorded its first HIV case in 1986, remains one of the most affected countries in the region. Despite an adult prevalence of 2.8%, Nigeria's large population results in about 3.1\u0026nbsp;million HIV cases, with a significant proportion of new infections occurring in West and Central Africa (PEPFAR, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; UNAIDS, 2017). About, 40% of Nigerians living with HIV are unaware of their status, largely due to limited access to treatment and prevention services (NAIIS, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In Nigeria, as in other African nations, unprotected heterosexual intercourse is the dominant mode of transmission, compounded by socio-economic challenges and high-risk behaviors among key populations.\u003c/p\u003e \u003cp\u003eAntiretroviral therapy (ART) plays a crucial role in suppressing the virus, restoring immune function, and reducing mortality (Nachega et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). However, treatment success relies heavily on retention in care and adherence, which are particularly challenging among adolescents due to factors such as risky sexual behavior, poor nutrition, and substance use (Kim et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Although progress has been made, adolescents in sub-Saharan Africa continue to face disproportionate challenges in staying engaged with HIV care programs.\u003c/p\u003e \u003cp\u003eTo address these issues, this study seeks to examine the factors influencing retention in care among adolescents and young adults receiving ART in Kogi State, Nigeria.\u003c/p\u003e \u003cp\u003eHowever, to mitigate the negative impact on this vulnerable population as efforts to combat HIV diseases among youngsters, this study seeks to examine the factors influencing retention in care among adolescents and young adults living with HIV who are receiving antiretroviral therapy (ART). By integrating global perspectives with local data, the study aims to provide evidence-based insights that can enhance ART adherence and promote long-term engagement in HIV care, ultimately contributing to improved health outcomes for this vulnerable population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design, settings and sample size estimation\u003c/h2\u003e\n \u003cp\u003eThe study employed a descriptive cross-sectional design using a multistage sampling technique to select 307 adolescent and young adult participants enrolled on ART of all the treatment centres in three senatorial districts in Kogi State. A structured questionnaire was used to collect the study data for bivariate and multivariate analysis using IBM SPSS version 26.0.\u003c/p\u003e\n \u003cp\u003eThe focused eligible respondents for this study were HIV-infected adolescents and young adults aged 10\u0026ndash;24 who had been initiated and enrolled in the antiretroviral therapy (ART) HIV treatment program in Kogi State, Nigeria. The inclusion criteria also include individuals currently in HIV care, ART treatment defaulters, and those classified as lost to follow-up were considered for the study. This approach ensured a comprehensive understanding of the link between adherence and retention to ART.\u003c/p\u003e\n \u003cp\u003eThe multistage sampling comprised three sequential stages where Kogi State was divided into three strata (Kogi West, Kogi Central, and Kogi East). In each stratum, a random selection of one healthcare facility providing comprehensive ART services by balloting, while the final stage involved selecting the last sample in the study.\u003c/p\u003e\n \u003cp\u003eThe total sample size for this study was determined using\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;\u003cspan style=\"text-decoration: underline;\"\u003e\u003cspan class=\"Underline\"\u003eZ\u003c/span\u003e\u003csup\u003e\u003cspan class=\"Underline\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003cspan class=\"Underline\"\u003ePq\u003c/span\u003e\u003c/span\u003e (Susan Rose, Nigel Spinks, \u0026amp; Ana Isabel Canhoto, 2015)\u003c/p\u003e\n \u003cp\u003ed\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eWhere n\u0026thinsp;=\u0026thinsp;sample size\u003c/p\u003e\n \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;Standard normal deviate at confidence interval of 95% = 1.96\u003c/p\u003e\n \u003cp\u003eP\u0026thinsp;=\u0026thinsp;Retention Prevalence Rate (RPR) among Adolescent and Young Adults in Kogi state\u0026thinsp;=\u0026thinsp;23.9% (NAIIS, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e\n \u003cp\u003eq\u0026thinsp;=\u0026thinsp;1 \u0026ndash; P (1- 0.239\u0026thinsp;=\u0026thinsp;0.761)\u003c/p\u003e\n \u003cp\u003ed\u0026thinsp;=\u0026thinsp;desired precision at 5%\u003c/p\u003e\n \u003cp\u003eTherefore,\u0026nbsp;\u0026nbsp;\u003cimg src=\"data:image/png;base64,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\" style=\"width: 249px;\"\u003e\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003eN\u0026thinsp;=\u0026thinsp;279\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eAdjusting for envisaged 10% non-response\u003c/p\u003e\n\u003cp\u003eN =\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\left(\\frac{10}{100}\\text{x}\\:\\:279\\right)+\\:\\:279}^{.}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;307\u003c/p\u003e\n\u003cp\u003eA total of 307 questionnaires were administered to respondents.\u003c/p\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003eThe Kogi State Ministry of Health\u0026apos;s Ethical Research Committee granted ethical approval for the study ensuring compliance with ethical guidelines for research involving human participants. Prior to data collection, informed consent was obtained from all participants, emphasising their right to voluntary participation and discontinuing if they wish to. Respondents were fully informed about the study\u0026apos;s objectives, and respondents\u0026apos; confidentiality was maintained. There was no potential risk whatsoever or danger to the participants.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eA structured, self-developed questionnaire (\u003cem\u003esee Appendix I\u003c/em\u003e) was used to collect the study data for descriptive, bivariate and multivariate analysis using IBM SPSS version 26. Descriptive statistics, including absolute frequencies, percentages, and bar chart were used to summarize the demographic characteristics of adolescents and young adults living with HIV, as well as their responses to questions on factors influencing retention in care. The bivariate analysis used chi-square statistic, and the multivariate analysis employed the logistic regression model to assess factors influencing retention in care using the odd ratio. Statistical significance was considered at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSocio-Demographic Characteristics of Respondents\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the socio-demographic profile of adolescents and young adults on antiretroviral therapy (ART) in Kogi State. The most common age group among respondents was 15\u0026ndash;19 (52.1%), followed by aged 20\u0026ndash;24 (35.2%), while the least represented age group was 10\u0026ndash;14 (12.7%). Over half (58.6%) of respondents were female, compared to their male counterparts (41.4%). Most respondents (85.7%) were single, while 14.3% were married. Regarding the respondents' educational attainment, nearly half (49.5%) had secondary education, while 23.8% had post-secondary education. A smaller proportion (6.8%) had primary education, while 19.9% had no formal education. Respondents' religious affiliation revealed a slightly higher proportion of Muslims (53.1%) than Christians (46.9%). Most of the respondents were Ebira (32.2%) indigenes and Igala (31.9%), followed by Yoruba indigenes (25%). Nearly two-thirds (59.6%) of respondents were students, slightly over one-tenth (13.7%) were gainfully employed, and 15.3% were either unemployed or actively seeking employment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;307\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoruba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEbira\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupational Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchooling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRespondents Duration of Antiretroviral Therapy (ART) Treatment and Co-morbidity\u003c/h3\u003e\n\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that the majority (80.5%) of participants had been on ART for four years, while 17.9% had been receiving ART for 5\u0026ndash;9 years, and a small fraction (1.6%) had been on treatment for over 10 years. Regarding spousal and family awareness of HIV status, 29.6% of respondents were aware that their spouse, child, or relative was also on ART, while 43.6% were unaware of their relative's HIV status. Similarly, 45.9% of respondents disclosed their HIV status to their spouse or family, while 32.2% had not disclosed their status.\u003c/p\u003e \u003cp\u003eExploring co-infection with other chronic illnesses, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that 17.6% of respondents had been diagnosed with Hepatitis B Virus (HBV) or Tuberculosis (TB). More than half (52.1%) of the respondents reported no chronic illness, while 30.3% were unaware of their co-morbidity status at the time of the study. Most respondents (81.1%) expressed willingness to take additional opportunistic infection (OI) medications to improve their health, whereas 10.7% declined, citing concerns over pill burden.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRespondents' Experience of Quality of Care at ART Treatment Centres\u003c/h2\u003e \u003cp\u003eThe study also assessed the perceived quality of care at ART centres. Most respondents (69.4%) felt respected and well-treated at their ART clinics, compared to one-fifth (20.5%) who felt otherwise. Regarding waiting times at healthcare facilities, 60.9% of respondents spent less than an hour during clinic visits, one-fifth (20.2%) spent 1\u0026ndash;2 hours, and 18.9% reported waiting for two or more hours. Respondents reported stock-outs of ARV medication, whereas over one-quarter (27.7%) reported experiencing ARV shortages at the ART centres. On the contrary, 30.0% reported having ART medications when due without ART stock-outs. Also, the cost analysis of HIV-related services revealed that 39.1% of respondents never paid for HIV services, such as receiving ART drug regimens and condoms, among other services, while a very minimal proportion (3.6%) of respondents allegedly made payments for ART services.\u003c/p\u003e \u003cp\u003eConsidering the ART patients' satisfaction with the ART services in the study location, less than half (41.4%) of respondents rated the ART services excellently, and 26.7% considered the ART service to be good. However, 31.9% of respondents rated the services as very poor. Interestingly, when asked about continuity of care, more than half (52.1%) of respondents would like to switch to a different ART centre, compared with 37.5% who preferred to continue receiving treatment at their current healthcare facility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing Retention in Care among Respondents\u003c/h2\u003e \u003cp\u003eThe study identified several key factors affecting retention among adolescents and young adults on ART in the study area. Nearly half (46.4%) of respondents opined that discrimination and stigmatisation are significant barriers to continued ART treatment. Transportation challenges accounted for 29.5%, and the distance to ART centres (3.6%) was also highlighted as an obstacle to retention in ART. Additionally, lack of trust in healthcare providers and time constraints accounted for 1.1%. The concerns for patient confidentiality were evident, with 7.2% of participants indicating that unauthorised disclosure of their HIV status by healthcare workers discouraged adherence to ART. The breach of confidentiality (3.2%) contributed to a lack of interest in ART, just as reported by the respondents. Other notable factors identified by the respondents were clinic appointments (2.9%) and the lack of attention and motivation after enrollment (5.0%).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows a bivariate analysis of factors determining participant retention in care. Among the key factors influencing ART retention, discrimination and stigmatisation were statistically significant, with retention in care (χ\u0026sup2; = 28.45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was a significant association between time constraints and retention care (χ\u0026sup2; = 12.63, p\u0026thinsp;=\u0026thinsp;0.001). Also, lack of interest in ARVs was statistically significant with respondents' retention in care (χ\u0026sup2; = 16.29, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, several factors did not show a significant relationship with retention in care. These include transportation difficulties (χ\u0026sup2; = 3.21, p\u0026thinsp;=\u0026thinsp;0.073), disclosure of HIV status by healthcare workers (χ\u0026sup2; = 0.76, p\u0026thinsp;=\u0026thinsp;0.384), frequency of clinic appointments (χ\u0026sup2; = 1.98, p\u0026thinsp;=\u0026thinsp;0.159), and lack of confidence in healthcare workers (χ\u0026sup2; = 0.45, p\u0026thinsp;=\u0026thinsp;0.502) were not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of factors that determine retention in care among participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChi-Square Value (χ\u0026sup2;)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDegrees of Freedom (df)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscrimination and Stigmatization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransportation Problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisclosure of HIV Status by Health Workers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of Clinic Appointments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime Constraints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of Confidence in Healthcare Workers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of Interest in ARVs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Analysis of Logistic Regression Model of Factors Influencing Retention in Care\u003c/h2\u003e \u003cp\u003eThe logistic regression analysis evaluates the factors influencing retention in care among vulnerable adolescents and young adults on ART. In Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the results highlight key predictors of retention, with odds ratios (OR) indicating the likelihood of how more predictive factors influence the dependent variable retention in care. Discrimination and stigmatisation were found to have a significant relationship with respondents' retention in care (β = -3.404, OR\u0026thinsp;=\u0026thinsp;0.033, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Stigma-related experiences by respondents were 0.033 more likely to influence retention in care. Time constraint was significantly associated with respondents' retention in care (β = -3.507, OR\u0026thinsp;=\u0026thinsp;0.030, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Time constraint was 0.030 more likely to influence ART care retention. Another critical factor was a lack of interest in ARVs (β = -3.507, OR\u0026thinsp;=\u0026thinsp;0.030, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), which was significantly associated with retention in care. Respondents' lack of interest was 0.030 more likely to influence retention in care.\u003c/p\u003e \u003cp\u003eIn contrast, transportation challenges were not statistically significant with respondents' retention in care (β = -0.720, OR\u0026thinsp;=\u0026thinsp;0.487, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Other factors, such as disclosure of HIV status by healthcare workers (β = -24.016, OR\u0026thinsp;=\u0026thinsp;0.000, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), lack of confidence in healthcare workers (β = -24.016, OR\u0026thinsp;=\u0026thinsp;0.000, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and frequency of clinic appointments (β = -24.016, OR\u0026thinsp;=\u0026thinsp;0.000, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), were not significantly predictors of retention in care.\u003c/p\u003e \u003cp\u003e*Significant level: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic Regression model of factors associated with retention among the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta Coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard\u003c/p\u003e \u003cp\u003eError\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald Statistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOdd Ratio\u003c/p\u003e \u003cp\u003e(OR)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConstant\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e163.558\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e57312.97\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.998\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1.078\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransportation problem.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscrimination and stigmatization.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisclosure of clients\u0026rsquo; status to others by health workers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-24.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8987.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of clinic appointment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-24.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14210.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime constraints.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.010*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of confidence in health care workers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-24.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23205.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of interest in ARVs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Significant level: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study identified stigma and discrimination, time constraints, and lack of interest in ART as significant barriers to retention in ART care among adolescents and young adults in Kogi State, Nigeria. While these factors echo findings from previous research (Clouse et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Kim et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), it is important to consider potential confounders. For instance, socioeconomic status and educational attainment could influence both an individual's experience of stigma and their ability to remain in care (Mofenson \u0026amp; Cotton, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Other studies, such as those by Alonge et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and Nachega et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), have noted that factors like baseline health status and mental health challenges also play a crucial role in ART adherence.\u003c/p\u003e \u003cp\u003eMoreover, variations in the quality and accessibility of healthcare services across different ART treatment centres may independently impact retention outcomes. Clinic-level factors, such as staff competence, appointment scheduling, and the availability of support services, have been shown to influence adherence in resource-limited settings (Bateganya et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In this context, the integration of decentralized ART services, such as mobile clinics, could mitigate the negative impact of these confounders by improving accessibility and service quality.\u003c/p\u003e \u003cp\u003eIn addition, healthcare accessibility, including the quality of services at different clinics, may confound the relationship between these barriers and retention outcomes. For example, research by Mukherjee et al. (2019) in similar resource-limited settings indicates that facility-level factors, such as staff attitudes and clinic organization, significantly affect retention rates. Differences in service delivery across regions could obscure the direct effects of individual-level barriers like stigma or treatment fatigue.\u003c/p\u003e \u003cp\u003eThe study found that time constraints significantly influence ART retention. This finding is consistent with findings from a study in South Africa by Nachega et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) that clinic schedules and long waiting times discouraged adolescent ART adherence. Similarly, a study in Nigeria by PEPFAR (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) indicated that young people often miss appointments due to academic commitments, work obligations, and family responsibilities. Innovative approaches such as flexible clinic hours, weekend ART clinics, and telemedicine-based consultations may be employed to tackle rigid clinic times and long waiting times.\u003c/p\u003e \u003cp\u003eThe study found that lack of motivation and interest in ART was a major predictor of non-retention. This study aligns with findings by Jaspan et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) that treatment fatigue was prevalent among adolescents and young adults, particularly those who had been on ART since childhood. Also, Msemburi et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) found that some young adults in South Africa discontinued treatment after achieving temporary viral suppression, mistakenly believing they were cured. To avoid ART discontinuation, targeted psychosocial interventions and counselling in youth-friendly ART services are essential to sustain long-term engagement in HIV care.\u003c/p\u003e \u003cp\u003eThis study revealed that transportation difficulties have nothing to do with retention in care for vulnerable adolescents and young adults; comparatively, other studies in sub-Saharan Africa have reported varying influences of logistical factors on ART retention. While our study found that transportation challenges and frequency of clinic visits were not statistically significant predictors of retention, research in Kenya and Zimbabwe has highlighted transportation barriers as critical to care engagement (Asiki et al., 2017; Takarinda et al., 2017). This discrepancy suggests that regional differences in healthcare infrastructure and community support systems can markedly influence retention outcomes. In settings where transportation remains a major challenge, the impact on retention may be more pronounced than in regions with better accessibility. UNAIDS (2018) reported that in rural sub-Saharan Africa, adolescents often travel long distances to access ART, contributing to high default rates. This study suggests that healthcare accessibility in Kogi State may be helpful, and expanding decentralised ART services into integrating mobile ART clinics may further improve treatment access and adherence.\u003c/p\u003e \u003cp\u003eAdditionally, the study found no significant association between HIV status disclosure by healthcare workers and retention. This is in contrast with findings from some other contexts, where breaches in confidentiality have been shown to discourage adherence (Shisana et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This divergence may stem from differences in local practices, data collection methods, or even cultural norms regarding privacy and stigma. A recent review by Mukherjee et al. (2019) emphasized that multifaceted interventions addressing both individual psychosocial factors and system-level barriers are crucial for improving retention rates. In this regard, the integration of flexible clinic schedules, mobile ART services, and robust psychosocial support mechanisms could mitigate some of the confounding factors influencing ART retention.\u003c/p\u003e \u003cp\u003eFuture research should incorporate these potential confounders through multivariable analyses and consider mixed methods approaches. Qualitative data could provide deeper insights into how factors such as socioeconomic status, mental health, and facility-level attributes interact with personal barriers to influence retention in ART care. Such an integrated approach would allow for a more nuanced understanding of ART adherence challenges, ultimately informing the design of targeted interventions that address both individual and systemic issues.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eThis study focused specifically on identifying the factors influencing ART retention among people living with HIV (PLHIV) in Kogi State. However, a key limitation was that the research was restricted to adolescents and young adults of the specified age, excluding other vulnerable age groups. Thus, results, perspectives and experiences of the broader HIV-positive population in the state were not captured, limiting the broader view of the findings. A qualitative study can be employed to gain a more comprehensive understanding of ART retention dynamics and conduct an in-depth analysis of the critical influencing factors on retention in care.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides critical insights into the factors influencing ART retention among adolescents and young adults in Kogi State, Nigeria. The critical challenge faced by adolescents and young adults to remain in care was greatly influenced by increased stigmatisation and discrimination, among other factors. Addressing these barriers can be promoted through a stigma reduction initiative approach and flexible clinic schedules for HIV-infected young adults and adolescents.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Health Research Ethics Committee of Kogi State Ministry of Health, Lokoja\u0026nbsp;(\u003cstrong\u003eRef: MOH/PRS/761/019\u003c/strong\u003e). Informed consent to participate was obtained from all participants, as well as from the parents or caregivers of those under the age of 16. This study was performed following the Helsinki Declaration of 2013.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003eFamily Health International (fhi360), Yola, Adamawa, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003eLadoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003eOsun State University, Osogbo, Osun, Nigeria\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/strong\u003eShared Approach Ltd. London, United Kingdom.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e5\u003c/sup\u003e\u003c/strong\u003eAIDS Healthcare Foundation, Lafia, Nasarawa, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003eUniversidade Estadual De Campus, Sao Paulo, Brazil.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlonge O, Babalola S, Uzochukwu B, Kieny MP. The impact of health system factors on retention in HIV care in Nigeria. BMC Health Serv Res. 2018;18(1):280. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-018-3163-4\u003c/span\u003e\u003cspan address=\"10.1186/s12913-018-3163-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBateganya M, Atuyambe L, Kambugu A, Ochen E. 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Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in Southern Africa. J Acquir Immune Defic Syndr. 2009;51(1):65\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Agency for the Control of AIDS (NACA). (2015). National HIV/AIDS strategic framework 2015\u0026ndash;2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNAIIS. (2018). Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018 Summary Sheet.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePEPFAR. (2019). Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018 Summary Sheet. President\u0026rsquo;s Emergency Plan for AIDS Relief (PEPFAR). (2019). Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018 summary sheet.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, Labadarios D, Onoya D. (2014). 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Hidden in plain sight: A statistical analysis of violence against children. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unicef.org/reports/hidden-plain-sight\u003c/span\u003e\u003cspan address=\"https://www.unicef.org/reports/hidden-plain-sight\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. (2018). HIV/AIDS fact sheet. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/hiv-aids\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/hiv-aids\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Health for the world\u0026rsquo;s adolescents: A second chance in the second decade. WHO; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). HIV and adolescents: Guidance for HIV testing and counseling and care for adolescents living with HIV. WHO; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Global HIV/AIDS response: Epidemic update and health sector progress towards universal access 2011. WHO; 2011.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV/AIDS, Adolescents, Young Adults, Retention in Care, Kogi State","lastPublishedDoi":"10.21203/rs.3.rs-6381509/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6381509/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eRetention in care remains an effective parameter to manage antiretroviral therapy (ART) uptake for adolescents and young adults living with HIV/AIDS around us. Adherence to ART treatments is significantly challenging in many ART treatment centres where Nigeria's budget for sustainable healthcare is limited. This study examines the factors that influence retention in care among adolescents and young adults living with HIV attending ART clinics in Kogi State, Nigeria, as insights to enhancing long-term engagement in HIV treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eThe study employed a descriptive cross-sectional design using a multistage sampling technique to select 307 adolescent and young adult participants enrolled on ART from all the treatment centres in three senatorial districts in Kogi State. A structured, self-developed questionnaire was used to collect the study data for bivariate and multivariate analysis using IBM SPSS version 26.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe study found that over half (52.1%) of respondents were adolescents in the age bracket 15–19 years, of which nearly two-thirds (58.6%) were female gender. Most (80.5%) of the youngsters had been initiated on the ART for nearly four years. The study revealed that a challenge in ART retention in care was significantly associated with incessant stigmatisation and discrimination (χ² = 28.45, p \u0026lt; 0.01). The study also revealed that lack of interest in ART was 0.030 more likely to influence adolescent and young adults' retention in care (β = -3.507, OR = 0.030, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eCritical challenges faced by adolescents and young adults to remain in care were greatly influenced by increased stigmatisation and discrimination, among other factors. Addressing these barriers can be promoted through a stigma reduction initiative approach and flexible clinic schedules for HIV-infected young adults and adolescents.\u003c/p\u003e","manuscriptTitle":"Factors Influencing Retention in Care among Adolescents and Young Adults Living with HIV Attending ART Clinic in Kogi State, Nigeria: A Quantitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-20 09:53:06","doi":"10.21203/rs.3.rs-6381509/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-11T13:51:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-09T10:45:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-06T21:44:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237719629729856138085633457765104670373","date":"2025-05-30T07:00:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109228184914337720765935906188681559895","date":"2025-05-29T11:52:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105270795790232043851204127623372113801","date":"2025-05-28T18:35:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-28T13:05:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249981658370983235838173760286827173260","date":"2025-05-24T22:17:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224227967094359530287441096478582371416","date":"2025-05-22T14:15:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330261156959039076353131653482419539202","date":"2025-05-16T10:50:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T10:07:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T08:55:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-15T04:13:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-14T15:04:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-04-14T15:03:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"890f0710-ed4a-48e3-8999-449429681510","owner":[],"postedDate":"May 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-20T09:53:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-20 09:53:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6381509","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6381509","identity":"rs-6381509","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}