HIV universal test and treat uptake and lost-to-follow-up rates among people living with HIV in Moretele Sub-district, South Africa

Abstract

The Universal Testing and Treatment (UTT) program aimed to improve human immunodeficiency virus (HIV) outcomes by initiating immediate antiretroviral therapy (ART). However, UTT faced challenges, including high attrition rates and loss to follow-up (LTFU), particularly in South Africa, where implementation has sometimes led to increased treatment discontinuation. This study investigated HIV UTT program uptake and LTFU rates among people living with HIV (PLWHIV) in Moretele Sub-district, South Africa. A quantitative, observational retrospective design evaluated UTT effectiveness in rural HIV care. Adult clients initiating ART between January 2020 and January 2022 across nine clinics in Moretele Sub-district were included. A random sample of 500 medical records was analyzed using Tier.net and DHIS software for record identification. Data analysis using STATA 18.0 included descriptive statistics, bivariate analysis, and logistic regression to identify factors influencing retention. Of 203 records analyzed, (30.8%) were aged 30–39, and 52.8% were female. Most clients were single (61.8%) and employed (51.6%). Same-day ART initiation was high (83.8%), yet 70% were LTFU, 25% transferred, 4.4% stopped treatment, and 0.6% died. Clients aged 30–39 had higher odds of LTFU (adjusted OR = 1.77; p=0.007). Gender, marital, and income status showed no significant association. While UTT enables rapid ART initiation, high LTFU rates, especially among younger, male, and employed individuals, hinder success. Strategies to improve retention should focus on same-day initiators and community engagement. This study highlights critical challenges in UTT implementation, emphasizing the need for targeted interventions to address LTFU and enhance retention in HIV care programs.