Losing Their Way: A Cohort Analysis of Retention in Care Among Adolescents on Antiretroviral Therapy in Lusaka District, Zambia

Background Retention in antiretroviral therapy (ART) is crucial for adherence, viral suppression, and preventing drug resistance. Adolescents (10-19 years) face retention challenges, affecting progress toward 95% viral suppression. Data on retention for this specific age bracket remains limited in Zambia. Methods A retrospective cohort analysis of 3978 adolescents on ART in Lusaka examined socio-demographic, clinical, treatment, and behavioral data. Kaplan–Meier estimates analyzed retention, and Cox regression identified associated factors using SPSS v29. Results Seventy percent remained in care, while 30% had interruptions, transfers, or death. Females (57.1%) had a higher non-retention risk (aHR: 1.21 [1.08-1.36]). Retention was lower in older adolescents (15-19 years, aHR: 0.11 [0.10-0.13]). Retention increased with early ART initiation with those starting ART at 15 to 19 years showed lowest retention (aHR: 578.50 [421.00-794.91]). Not changing ART regimens decreased retention (aHR: 0.88 [0.77-0.99]). Conclusions Targeted interventions should prioritize females, older adolescents, early ART initiation, and regimen changes.