Retention in HIV Pre-Exposure Prophylaxis Among Men Who Have Sex with Men in Tanga, Tanzania

Purpose: Men who have sex with men are at high risk of Human immunodeficiency virus (HIV) infection and bear the highest burden of the disease in Tanzania. Although pre-exposure prophylaxis (PrEP) has demonstrated high efficacy in the prevention of HIV infection in clinical trials, challenges with retention threaten its effectiveness. Therefore, we assessed the extent and predictors of retention in PrEP care among men who have sex with men in Tanga, Tanzania. Methods: This study included 369 men who have sex with men who were recruited using respondent-driven sampling. Baseline data were collected using structured questionnaires that captured socio-demographic and behavioral characteristics. The primary outcome was one-month retention in PrEP care. A statistical analysis using modified Poisson regression was conducted to identify independent factors associated with 1-month retention. Results: A total of 369 men (mean age, 24.7 (+/- 5.5 years)) participated in the study. After one month, 87 participants (23.6%) were retained in PrEP care. Independent factors associated with retention included assuming a receptive position in anal sex (aPR 1.6, 95 CI: 1.0-2.6, p = 0.030), having initiated sexual activity with anal, oral, or thigh sex (aPR 2.1, 95% CI: 1.2-3.8, p = 0.011), and having adequate social support (aPR: 1.6, 95% CI: 1.0-2.6, p = 0.030). Conclusion: Tailored interventions that improve social support and address the varying needs of men who have sex with men with diverse sexual behavior patterns are essential for improving retention and maximizing the effectiveness of PrEP in HIV prevention. Practically, this highlights the need to strengthen supportive environments within communities and healthcare systems to enhance retention in PrEP, reduce HIV transmission, and advance progress toward ending HIV as a public health threat by 2030.