# Retention of clients in HIV oral pre-exposure prophylaxis care in Engela, Namibia

## TL;DR

This study examines why some people in Namibia stop using HIV prevention medication and finds that unemployed men and those in certain relationships are less likely to continue.

## Contribution

The study identifies specific demographic and socioeconomic factors associated with low retention in PrEP care in a Namibian district.

## Key findings

- Only 35.6% of participants remained in PrEP care after 3 months.
- Unemployed individuals and men were less likely to stay in PrEP care.
- Decentralizing PrEP services and community-based models could improve retention.

## Abstract

Namibia has made tremendous progress in controlling the HIV epidemic. The progress has resulted in significant incidence and AIDS-related mortality reductions. However, new infections continue to persist.

The study aimed to measure the clients’ retention rate in pre-exposure prophylaxis (PrEP) care and associated factors.

Engela District, in Namibia’s Ohangwena region.

We chose an analytical cross-sectional study design for this study. We selected 275 participants using a proportional stratified random sampling method. We used a self-administered questionnaire to collect data. We employed Chi-square tests and logistic regression for data analysis.

Participants’ retention rate in PrEP care at 3 months was 35.6%, 95% CI (35.2% – 36.0%). Binomial logistic regression showed that men and the unemployed were less likely to be retained in PrEP, crude odds ratio (OR) = 0.52, 95% CI (0.30–0.91), and OR = 0.27, 95% CI (0.15–0.49), respectively. Participants who were divorced or in a relationship were also less likely to be retained in PrEP care, OR = 0.41, 95% CI (0.18–0.96), and OR = 0.43 95% CI (0.23 – 0.80), respectively. Furthermore, participants at Engela District Hospital were less likely to be retained in PrEP care, OR = 0.52, 95% CI (0.29 -0.93).

Addressing the specific challenges unemployed individuals face in continuing on PrEP is crucial. Strategies should include decentralising PrEP services in the district and employing community-based models.

In addition, comprehensive PrEP education targeting men should be provided in diverse settings to improve their PrEP knowledge.