Who will be lost? Identifying patients at risk of loss to follow‐up in Malawi. The DREAM Program Experience

Nielsen‐Saines, Karin; Germano, Paola; Guidotti, Giovanni; Buonomo, E; Scarcella, P; Lunghi, R; Sangare, H; Orlando, Stefano; Liotta, Giuseppe; Marazzi, Mc; Palombi, Leonardo

doi:10.1111/hiv.12492

Cited by 18 publications

(14 citation statements)

References 27 publications

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“…One study found that women initiated on ART under Option B+ approach were 5 times more likely to drop out of care than those that started ART for their own health 20 . In our study, similar to a previous study, health care workers reported that most women dropped out of care when their infants tested HIV negative during the postpartum follow-up period 26 . This highlights the need for improved counselling of HIV-positive mothers at ART initiation and during follow-up on the long term benefits of ART on the mother's health and prevention of HIV-mother-to-child transmission 14,18,22 .…”

Section: Discussionsupporting

confidence: 89%

Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

Mpinganjira

Tchereni

Gunda

et al. 2020

Preprint

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Background In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated to be 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced and interviewed 19 LTFU women. In addition, we interviewed 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed, translated and then analysed using deductive content analysis. Results The following reasons were reported as contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; poverty; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system levels, which contribute to poor retention of mother-infant pairs in HIV care. Key words PRIME, PMTCT, loss to follow up, mother-infant pairs, retention, Option B+

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Section: Discussionsupporting

confidence: 89%

Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

Mpinganjira

Tchereni

Gunda

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…One study found that women initiated on ART under Option B+ approach were 5 times more likely to drop out of care than those that started ART for their own health [20]. In our study, similar to a previous study, health care workers reported that most women dropped out of care when their infants tested HIV negative during the postpartum follow-up period [26]. This highlights the need for improved counselling of HIV-positive mothers at ART initiation and during follow-up on the long term benefits of ART on the mother's health and prevention of HIV-mother-to-child transmission [14,18,22].…”

Section: Discussionsupporting

confidence: 87%

“…Previous studies have explored different reasons for LTFU of HIV-positive mothers and their exposed children. These include: lack of husband support [10][11][12][13][14]; stigma [10,12,[14][15][16][17][18]; distance and transport costs [10-12, 17, 19]; poor attitude of health workers [3,17,20]; food shortage [3,21]; inadequate counselling [14,22,23]; perceived wellness [24][25][26]; side effects of ART [21,23]; gender inequality; lack of privacy at ART clinics; lack of access to care and treatment; and involuntary HIV disclosure [10-12, 21, 22, 27].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with loss-to-follow-up of HIV-positive mothers and their infants enrolled in HIV care clinic: A qualitative study

et al. 2020

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Background: In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated to be 74% at 12 months postpartum. This threatens Malawi's efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods: We conducted a qualitative study, nested within the "Promoting Retention Among Infants and Mothers Effectively (PRIME)" study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced and interviewed 19 LTFU women. In addition, we interviewed 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed, translated and then analysed using deductive content analysis. Results: The following reasons were reported as contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; poverty; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion: Our study has found multiple factors at personal, family, community and health system levels, which contribute to poor retention of mother-infant pairs in HIV care.

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“…Traditional risk factors such as male sex, suboptimal adherence, low CD4 cell count, high VL and being hepatitis C coinfected were shown to be associated with LTFU, consistent with other studies . Our study also found that those from high‐income countries were less likely to be LTFU.…”

Section: Discussionsupporting

confidence: 91%

Long‐term loss to follow‐up in the TREAT Asia HIV Observational Database (TAHOD)

Jiamsakul

Kiertiburanakul

et al. 2019

HIV Medicine

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ObjectivesWith earlier antiretroviral therapy (ART) initiation, time spent in HIV care is expected to increase. We aimed to investigate loss to follow-up (LTFU) in Asian patients who remained in care 5 years after ART initiation. MethodsLong-term LTFU was defined as LTFU occurring after 5 years on ART. LTFU was defined as (1) patients not seen in the previous 12 months; and (2) patients not seen in the previous 6 months. Factors associated with LTFU were analysed using competing risk regression. ResultsUnder the 12-month definition, the LTFU rate was 2.0 per 100 person-years (PY) [95% confidence interval (CI) 1.8-2.2 among 4889 patients included in the study. LTFU was associated with age > 50 years [sub-hazard ratio (SHR) 1.64; 95% CI 1.17-2.31] compared with 31-40 years, viral load ≥ 1000 copies/mL (SHR 1.86; 95% CI 1.16-2.97) compared with viral load < 1000 copies/mL, and hepatitis C coinfection (SHR 1.48; 95% CI 1.06-2.05). LTFU was less likely to occur in females, in individuals with higher CD4 counts, in those with self-reported adherence ≥ 95%, and in those living in high-income countries. The 6-month LTFU definition produced an incidence rate of 3.2 per 100 PY (95% CI 2.9-3.4 and had similar associations but with greater risks of LTFU for ART initiation in later years (The long-term LTFU rate in our cohort was low, with older age being associated with LTFU. The increased risk of LTFU with later years of ART initiation in the 6-month analysis, but not the 12-month analysis, implies that there was a possible move towards longer HIV clinic scheduling in Asia.

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Who will be lost? Identifying patients at risk of loss to follow‐up in Malawi. The DREAM Program Experience

Abstract: Educated, urbanized HIV-infected adults living far from programme centres are at high risk of LTFU, particularly if there is no maternal figure in the household. These variables must be taken into consideration when developing retention strategies.

Cited by 18 publications

References 27 publications

Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

Factors associated with loss-to-follow-up of HIV-positive mothers and their infants enrolled in HIV care clinic: A qualitative study

Long‐term loss to follow‐up in the TREAT Asia HIV Observational Database (TAHOD)

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