Treatment attrition and mortality among women receiving antiretroviral therapy in West Java, Indonesia: a retrospective competing risks analysis

This retrospective cohort study examined program attrition among women receiving antiretroviral therapy (ART) at Bandung City Regional General Hospital, Indonesia, between 2006 and 2023. Using data from the national HIV/AIDS Information System (SIHA), we analyzed loss to follow-up (LTFU) and mortality using competing risks regression. Among 149 women initiating ART, overall program attrition was high: only 38% remained in care after a median follow-up of two years, while 36% had died and 26% were lost to follow-up. Younger women (≤30 years) were substantially more likely to disengage from care, as were those receiving efavirenz-based regimens and those with poor adherence. In contrast, women with advanced HIV disease were less likely to be lost to follow-up, indicating that advanced disease status was associated with higher retention. Women with opportunistic infections, tuberculosis, pregnancy, or a history of injection drug use were also less likely to disengage, demonstrating the advantages of differentiated service models. These findings underscore the critical need for individualized care and intensive case management to address the high rates of attrition and mortality. Interventions must go beyond regimen optimization to include accelerated transition to better-tolerated ART, proactive tracking for younger women, and holistic support systems that ensure survival and retention.