Factors Associated With Loss-to-follow-up Of Hiv-positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

Abstract

Background In Malawi, loss to follow-up (LTFU) greatly contributes to sub-optimal retention (74%) of HIV-positive (HIV+) women initiated on antiretroviral therapy (ART) during pregnancy under Option B+ strategy. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs (MIP). 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 MIPs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced 19 LTFU women and conducted in-depth interviews (IDIs) with them and also with 30 healthcare workers (HCWs) from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed and translated and, then, analysed using deductive content analysis. Results The following reasons were reported contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; food insecurity; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system level which contribute to poor retention of MIPs in HIV care. Key words PRIME, PMTCT, eMTCT, loss to follow up, mother-infant pairs, Option B+

Factors Influencing Loss to Follow-up among Human Immunodeficiency Virus Exposed Infants in the Early Infant Diagnosis Program in Phalombe, Malawi

“…26 It has been argued that healthier babies become lost to follow up with successive HIV negative results. 25 This finding resonates well with the Health Belief Model that contends that one's perception of susceptibility to a certain threat determines their response and also that if the threat is minimal, one may relax in their response like it was observed in the study. 13 It is important that the messaging to mothers of children who test HIV negative whilst still on the program emphasize on the possibility of a child contracting HIV if the exposure remains.…”

“…Our finding that a quest for a healthy child motivates a mother to retain in EID of HIV services is similar to earlier studies that reported of women being motivated and encouraged to engage in EID services because of the benefits realized. [22][23][24] Furthermore, Mpinganjira et al 25 reported that perceived good health after taking ART was another motivating factor for continuing with follow up. This resonates with the tenet of perceived susceptibility under the HBM which we contextualized as the likelihood of a mother transmitting HIV to her infant and this was a motivating factor for a mother to protect the child hence continued with the follow-up visits in EID.…”

“…[24][25][26] In Malawi, women harbored a poor understanding of the indication and purpose of ART consequently resulting in women whose children tested HIV negative at 9 to 12 months disengaging from PMTCT and EID services despite receipt of prior counseling about the risk of infection during breast feeding. 25 Similarly in Kenya, children that were perceived to be healthy coupled with a negative HIV test were less likely to be linked to HIV care because their caretakers had concluded that the children were negative and only brought them to the clinic when they developed an acute illness. 26 It has been argued that healthier babies become lost to follow up with successive HIV negative results.…”

“…The burden created by the long distances resulting in a reluctance to continue with EID services is similar to an earlier Malawian study that reported that mothers of HEI found carrying their children to the clinics exhausting. 25 The minimal perception of risk of MTCT coupled with the long distance is explained within the HBM that a mother may not follow through with the expected visits. 13 Disclosure of an HIV infected status remains a critical barrier to accessing HIV services.…”

Factors Associated with Follow-Up of Children Exposed to Mother-to-Child Transmission of HIV: A Historical Cohort Study Form 2000 to 2017, in Porto Alegre, Brazil.

“…Loss to follow-up is de ned as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Loss to follow-up is a current problem and has been documented in other countries [17,[22][23][24][25].…”