BACKGROUND: Anti-retroviral therapy averts morbidity and mortality among patients with HIV, however high rates of loss to follow-up and early mortality in the first year are commonly reported setbacks. OBJECTIVE: To determine predictors of loss to follow-up and death among people living with HIV with age ≥15 years in the first 12 months of starting antiretroviral therapy in Dodoma urban district. METHODS: Analysis of routinely collected data was carried out for people living with HIV who started antiretroviral therapy in the period 2010-2013, aged ≥15years from purposely selected health facilities 3 were urban and 2 rural located. Follow-up period was fixed at 12 months in order to make comparison of program improvement overtime. Predictor of both loss to follow-up and death were estimated by risk ratio which was adjusted. RESULTS: A total of 3844 people living with HIV on ART was involved in the analysis, 70% were females. HIV infected patients with CD4<200cells/μl had statistically significant associated with both loss to follow-up and death. Age and sex were not determinants of loss to follow-up. Mortality was significantly male sex determined, but not age. Urban health facilities had statistically significant high prevalence of loss to follow-up. Trends of the antiretroviral program show declining of both mortality and loss to follow-up with time. CONCLUSION: Trend over time shows improvement, but still more to do. Retention and survival rate were associated with higher CD4 counts. Earlier initiation of therapy when CD4≥200 cells/μl and strengthening systems may improve retention and contribute to better clinical outcomes. KEYWORDS People living with HIV, anti-retroviral therapy , loss to follow-up, death, Dodoma urban district, Tanzania.