In Tanzania, poor retention rates among pregnant and breastfeeding mothers continue to be a problem, contributing to a mother-to-child HIV transmission rate of 11% in 2019, compared to a global target of 5%. The goal of this study was to determine the influence of retention on clinical outcomes and identifying predictors of attrition among HIV-positive pregnant and breastfeeding women from follow-up care in Dar es Salaam. A retrospective cohort study included HIV-positive women who engaged in PMTCT services in public and private health facilities between January 2016 and December 2019. Secondary data were extracted from databases used for routine follow-up in care and treatment clinics (CTCs). The estimates of cumulative incidences of poor retention from date of enrollment or ART initiation were assessed using Kaplan–Meier method. The Cox regression model was used to identify the predictors of attrition. Among 20,225 HIV-infected pregnant and lactating women enrolled in PMTCT services, 93.35%, 89.07%, and 85.24% were classified as retained in care at 12, 24, and 36 months, respectively. The attrition rate at the end of the follow-up period was 15.82%, and WHO clinical stages 3 or 4 (aHR = 1.67, 95% CI: 1.46–1.89; p-value < 0.001) and unsuppressed viral load (aHR = 3.79, 95% CI: 3.20–4.49; p-value < 0.001) were predictors of increased risks of attrition. The maternal age group 25–34 years (aHR = 0.24, 95% CI: 0.18–0.32; p-value < 0.001), being married or cohabiting (aHR = 0.45, 95% CI: 0.38–0.55; p-value < 0.001), an efavirenz (EFV)-based regimen (aHR = 0.26, 95% CI: 0.19–0.35; p-value < 0.001), and good adherence to ART (aHR = 0.61, 95% CI: 0.48–0.79; p-value < 0.001) were factors associated with reduced risks of attrition. The study shows that a strong tracking system for lost to follow-up (LTFU), that is, patients who miss appointments to the same health facility for more than 3 months after the last scheduled clinical visit, should be prioritised for successive PMTCT programmes for better clinical outcomes. Keywords:  Retention, Attrition, Treatment, Clinics, Loss-to-follow up

HIV/AIDS remains an important global cause of morbidity and mortality. While medical male circumcision and condom and microbicides use hold great promise for helping to stem the tide of new HIV infections, theoretically providing further evidence of the potential long-term population-level benefit of their combined effects is viable. A deterministic sex-structured model is formulated, the expected lifetime disease reproductive output of an individual (or epidemiological birth) is determined, and the stability of steady states is investigated. To complement HIV treatment with antiretrovirals, which is not yet fully accessible to all those in need, microbicides and nontherapeutic measures such as male circumcision and condoms provide additional potential impact on curtailing the spread of HIV/AIDS.

Despite Tanzania's efforts and substantial progress in PMTCT, about 11% new infections were recorded among Tanzanian children in 2019 (UNAIDS 2020a). The objective of this study was to determine the rate of HIV transmission and to identify its risk factors among HIV exposed infants born to HIV-positive mothers in Dar es Salaam, Tanzania. A cross-sectional study was conducted using retrospective data collected from HIV-positive mothers and their exposed babies who were followed and registered in health facilities in four administrative districts (Ilala, Temeke, Kinondoni, and Ubungo) in Dar es Salaam between January 2016 and December 2019.  To identify risk factors for MTCT, univariate and multivariate Cox Proportional hazard regression analyses were employed. Out of 18705 registered children exposed to HIV, 586 (3.1%) were positive during the study period, while 18119 (96.9%) were negative. In this study, the following factors were increasing the risks of MTCT of HIV infections, not receiving ARV prophylaxis right at birth (aHR = 2.39, 95% CI: 1.75–3.26, P < 0.001), unsuppressed maternal viral load (aHR = 6.26, 95% CI: 4.91–7.97, P < 0.001), WHO clinical stage 3–4 (aHR = 1.79, 95% CI: 1.44–2.23, P < 0.001), and mixed feeding (aHR = 4.09, 95% CI: 1.80–9.31, P < 0.001). The factors maternal age group 25–34 years (aHR = 0.47, 95% CI: 0.29–0.75, P < 0.001), being married/cohabiting (aHR = 0.47, 95% CI: 0.23–0.95, P = 0.036), duration on ART for > 12 months (aHR = 0.55, 95% CI: 0.45–0.67, P < 0.001), dried blood spot (DBS) tested at 6 weeks (aHR = 0.09, 95% CI: 0.04–0.18, P < 0.001), and exclusive replacement feeding (ERF) (aHR = 0.32, 95% CI: 0.17–0.60, P < 0.001) decreased the risk of MTCT of HIV infections. These findings indicated that further work is required to scale up PMTCT approaches to concentrate on viral load suppression, taking ARV prophylaxis immediately at birth, and EBF practice in the first 6 months of life. Keywords: HIV, PMTCT, risk factors, mother-to-child transmission (MTCT).