Associated Factors with Non-retention of People Living with HIV in the Antiretroviral Treatment Program at the Donka National Hospital, Conakry: A Five-year Retrospective Cohort Study (2018 - 2023)

Background: This study assesses the retention rate of patients living with HIV in the antiretroviral treatment (ART) program at Donka the National Hospital, Guinea, and identifies predictors of non-retention. Methods: Conducted as a retrospective cohort study from May 2018 to March 2023, it involved 4,169 HIV-positive patients aged 10 and older, who had been on antiretroviral treatment program for at least six months. Retention rates were estimated using Kaplan-Meier techniques, and multivariate Cox regression identified factors associated with non-retention. Results: Results showed a cumulative retention rate of 68.88%, declining over time: 91.3% at six months, 74.1% at 24 months, and 53.1% at 60 months. The study identified significant predictors of non-retention, including low CD4 counts (<100 cells/mm³: adjusted HR 2.158; 100-200 cells/mm³: adjusted HR 1.729), advanced HIV stages (III/IV) at treatment initiation (adjusted HR 1.335), and the use of "AZT + 3TC + NVP" regimen (adjusted HR 1.443). Most participants were women (66.2%) with a median age of 37 years, and a majority were unemployed (57.8%). Conclusion: The findings highlight a retention rate below the national target of 90%, with late treatment initiation and low CD4 counts as major barriers. The study calls for further qualitative and quantitative research to understand patient loss to follow-up and improve ART program retention and HIV care in Guinea.