Retention of pregnant women living with HIV across health care levels in Sierra Leone

SETTING: The study was conducted across three health facilities in Sierra Leone, Princess Christian Maternity Hospital (tertiary), Rokupa Government Hospital (secondary), and George Brook Community Health Centre (primary). OBJECTIVES: To assess retention rates and identify factors associated with continued engagement of pregnant women living with HIV (PWLHIV) in antenatal and postnatal care. METHODS: A retrospective cohort study using 2024 routinely collected antenatal and elimination of mother-to-child transmission (eMTCT) data. Retention during antenatal and postnatal care was retrospectively assessed. Data were analysed, applying Poisson regression models to estimate relative risks. RESULTS: Of 397 PWLHIV enrolled, 84 (21.1%) were retained in antenatal care and 79 (25.9%) in postnatal care. Higher antenatal retention was linked to being newly diagnosed with HIV (adjusted relative risk [aRR] = 7.67), having no formal education (aRR = 2.99), and older age. These factors also predicted postnatal retention, with adjusted relative risks of 14.30 for newly diagnosed women, 1.34 for older women, and 2.96 for those with no formal education. CONCLUSION: Retention of pregnant and postpartum women living with HIV is low. Newly diagnosed, older, and less-educated women have better retention, while younger and already aware women struggle with engagement. We recommend enhanced counselling and targeted re-engagement strategies.