Incidence and predictors of lost to follow-up among women under Option B+ PMTCT program in western Ethiopia: a retrospective follow-up study

Tolossa, Tadesse; Kassa, Getachew Mullu; Chanie, Habtamu; Abajobir, Amanuel Alemu; Mulisa, Diriba

doi:10.1186/s13104-019-4882-z

Cited by 20 publications

(28 citation statements)

References 20 publications

(27 reference statements)

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“…The risk of LTFU among women who were on ART before PMTCT enrolment was lower than those who enrolled newly to PMTCT. This nding agreed with studies done in in different countries in African region (19,23,30). The possible explanations for this might be a known HIV woman and on ART before enrolment had experienced with ART treatment and might have good awareness about ART treatment, drug side effects and drug adherence than a newly enrolled woman.…”

Section: Discussionsupporting

confidence: 90%

“…The current study showed that risk of LTFU among women who are residing in rural area is higher as compared to women residing in urban. Supportive ndings were reported from previous studies in Ethiopia and Brazil (10,30,48). Possible explanations for this might be remote area mothers are forced to travel long distances in order to get the nearest hospital, which necessarily involves high costs which leads LTFU (16) and cannot easily get transport services due to poor /lack of road construction, makes women to walk long distances by bare foot, this leads them less likely to adhere to option B+ strategy (31) and resulting in missing the appointments (15,32).…”

Section: Discussionsupporting

confidence: 85%

“…A retrospective follow-up study at different public health facilities in Northeast regions of Ethiopia showed that cumulative incidence LTFU was 16.5% (29). Similar nding also revealed that cumulative incidence of LTFU was 15.4% with incidence rate of 9 per 1000 person-months in western Ethiopia (30) and 18.2% in Southern Ethiopia (31).…”

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confidence: 66%

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Incidence and Predictors of Loss-to-follow-up Among Pregnant and Breastfeeding Women on Option B+ PMTCT Program in Northwest Ethiopia: a Retrospective Follow-up Study.

Baraki¹,

Yenit²

2020

Preprint

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Background: Although Ethiopia is implementing an option B+ program for the last seven years, lost to follow-up among HIV positive women remains the major problem for ART treatment. The study was conducted on lost to follow-up among human immunodeficiency virus infected pregnant and breastfeeding women after Option B+ modality since there was a scarcity of literatures in Northwest Ethiopia. The result is also expected to strengthen the effort to eliminate mother-to-child transmission of HIV to 5%. Methods: A retrospective follow-up study was conducted among 403 pregnant and breastfeeding women between June 2013 and December 2019 at the University of Gondar comprehensive specialized Hospital. Cox proportional hazards regression model was used for identifying predictors of lost-to-follow-up. Results were reported as hazard ratios with 95% confidence interval at a significance level of p=0.05. Results: The overall incidence rate of loss to follow-up was 9.4 per 1000 person-months of observation (95% confidence interval (CI): 7. 4‒11. 9). According to the multivariable Cox regression, rural residency (adjusted hazard ratio(AHR): 2.30; 95% CI:1.08‒4.88), being Muslim religion follower (AHR: 2.44; 95% CI:1.23‒4.81), having no baseline viral load measurement (AHR: 4.21; 95% CI:2.23–7.96, being on ART before enrolment (AHR: 0.30; 95% CI:0.15–0.62), having drug side effects (AHR: 1.82; 95% CI:1.01–3.33), same day ART initiation (AHR: 3.23; 95% CI:1.53–6.84) and having sub-optimal adherence level (AHR: 3.96; 95% CI:2.18–7.19) were significant predictors of lost to follow up.Conclusion: The incidence of lost to follow-up is lower as compared to evidence from most African countries but slightly higher than the WHO target. It is better to strength and expand viral load measurement for all women and giving attention to those women who are residing in a rural area and having fair/poor adherence level.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 85%

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Incidence and Predictors of Loss-to-follow-up Among Pregnant and Breastfeeding Women on Option B+ PMTCT Program in Northwest Ethiopia: a Retrospective Follow-up Study.

Baraki¹,

Yenit²

2020

Preprint

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“…The rate of loss-to-follow-up in most of the sub-Saharan countries range from as low as 9.6% to a high of 61% depending on the level of PMTCT cascade and settings [ 17 ]. The prevalence rate of LTFU is estimated to be between 9 and 14.8 per 1000 person-months of the option B+ cascade [ 18 ]. LTFU disrupt the Option B+ cascade and increase the risk of mother-to-child HIV transmission, and lead to poor health outcomes for both the mother and child including advancing of HIV stages and maternal and child mortality [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence rate of LTFU is estimated to be between 9 and 14.8 per 1000 person-months of the option B+ cascade [ 18 ]. LTFU disrupt the Option B+ cascade and increase the risk of mother-to-child HIV transmission, and lead to poor health outcomes for both the mother and child including advancing of HIV stages and maternal and child mortality [ 18 – 20 ]. Evidence shows that younger age, lack of education, stigma and discrimination, failure to disclose HIV-status, long distances to reach health facilities, long waiting times, poor adherence to treatment, high CD4 count and WHO clinical stage I, II were associated with LTFU [ 21 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

The perceived determinants and recommendations by mothers and healthcare professionals on the loss-to-follow-up in Option B+ program and child mortality in the Amhara region, Ethiopia

et al. 2020

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Background The third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16 to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU. The purpose of this study is to explore perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants’ mortality. Method Explorative, descriptive qualitative study conducted in five zones of Amhara region. The sample consisted of mothers enrolled to the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes. Results Overall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment. Conclusions Social and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation.

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Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania

Urrio,

Lyatuu,

Sando

et al. 2024

J Int AIDS Soc.

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IntroductionTo prevent vertical HIV transmission and ensure healthy mothers and children, pregnant women with HIV must remain on antiretroviral treatment (ART) for life. However, motivation to remain on ART may decline beyond the standard 2‐year breastfeeding/postpartum period. We assessed attrition and retention in ART care among women with HIV up to 6 years since enrolment in vertical transmission prevention services in Dar es Salaam, Tanzania.MethodsA prospective cohort of 22,631 pregnant women with HIV were enrolled in vertical transmission prevention services between January 2015 and December 2017 in routine healthcare settings and followed‐up to July 2021. Kaplan−Meier was used to estimate time to ART attrition (died, stopped ART or was lost to follow‐up [no show ≥90 days since scheduled appointment]) and the proportion retained in care. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) of ART attrition in relation to predictors.ResultsParticipants were followed‐up to 6 years for a median of 3 years (IQR: 0.1–4). The overall ART attrition rate was 13.8 per 100 person‐years (95% CI: 13.5–14.1), highest in the first year of enrolment at 27.1 (26.3–27.9), thereafter declined to 9.5 (8.9–10.1) in year 3 and 2.7 (2.1–3.5) in year 6. The proportion of women retained in care were 78%, 69%, 63%, 60%, 57% and 56% at 1, 2, 3, 4, 5 and 6 years, respectively. ART attrition was higher in young women aged <20 years (aHR 1.63, 95% CI: 1.38–1.92) as compared to 30‐39 year‐olds and women enrolled late in the third versus first trimester (aHR 1.29, 95% CI: 1.16–1.44). In contrast, attrition was lower in older women ≥40 years, women who initiated ART before versus during the index pregnancy and women attending higher‐level health facilities.ConclusionsART attrition among women with HIV remains highest in the first year of enrolment in vertical transmission prevention services and declines markedly following a transition to chronic HIV care. Targeted interventions to improve ART continuity among women with HIV during and beyond prevention of vertical transmission are vital to ending paediatric HIV and keeping women and children alive and healthy.

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Incidence and predictors of lost to follow-up among women under Option B+ PMTCT program in western Ethiopia: a retrospective follow-up study

Cited by 20 publications

References 20 publications

Incidence and Predictors of Loss-to-follow-up Among Pregnant and Breastfeeding Women on Option B+ PMTCT Program in Northwest Ethiopia: a Retrospective Follow-up Study.

Incidence and Predictors of Loss-to-follow-up Among Pregnant and Breastfeeding Women on Option B+ PMTCT Program in Northwest Ethiopia: a Retrospective Follow-up Study.

The perceived determinants and recommendations by mothers and healthcare professionals on the loss-to-follow-up in Option B+ program and child mortality in the Amhara region, Ethiopia

Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania

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