Loss to Follow-Up Among HIV-Exposed Children in an HIV Clinic in Beira, Mozambique

Abstract

Loss to follow-up contributes to the low coverage of HIV care interventions among HIV-exposed infants in Beira, Mozambique. This qualitative study explores the perceptions of HIV-infected women and their health care providers regarding the main obstacles preventing women from attending follow-up visits for HIV care, and factors influencing women's decisions about newborn care. Fifty-two in-depth interviews and two focus group discussions were conducted; transcripts were coded and analyzed using ATLAS.ti. Interviewees perceived three major barriers to follow-up: food insecurity, difficulties navigating the health system, and women's familial roles and responsibilities. Our findings unveil the complex context in which HIV-infected women and their children live, and suggest that the structure and function of the HIV care system should be reviewed. Economic empowerment of women is crucial to achieving better compliance with medical care. Integration of mother and child services and more efficient and culturally sensitive medical services may improve follow-up. KeywordsHIV/AIDS, loss to follow-up, adherence, HIV care, access barriers 2 SAGE Open Maman, 2007;Manzi et al., 2005;Painter et al., 2005). Finally, structural factors, including the physical, social, cultural, organizational, community, economic, or policy aspects of the environment, can act as barriers or facilitators to individually oriented HIV prevention and care services (Blankenship, Bray, & Merson, 2000;Farmer, 2004;Farmer, Leandre, et al., 2001;Gupta, Parkhurst, Ogden, Aggleton, & Mahal, 2008;Jones et al., 2005;Parker, Easton, & Klein, 2000;Sumartojo, Doll, Holtgrave, Gayle, & Merson, 2000).However, few data have been systematically collected in Mozambique on the conditions that affect the lives of HIVpositive women and their children on a daily basis, and how these conditions affect their acceptance and utilization of HIV care services. We therefore conducted a qualitative study to determine the factors affecting women's decision to seek HIV care and adhere to follow-up visits for themselves and their newborn babies. MethodWe conducted a cross-sectional qualitative study of a subset of women participating in an observational cohort study of nevirapine (NVP) resistance following prophylaxis with singledose nevirapine, which started in June 2005 and ended in December 2008 (Micek et al., 2010). Briefly, the study enrolled mothers and newborn infants participating in PMTCT programs at three clinics in Beira, Mozambique. Infants were supposed to make five study visits through 8 weeks of age, at which time questionnaires were administered and blood samples taken for analysis of HIV infection and NVP resistance (Blankenship et al., 2000). Similar to the PMTCT program from which participants were recruited, study-related followup of infants was poor, with 57% (499/875) of enrolled infants missing >2 successive scheduled study visits. We investigated the reasons for LTFU in this already assembled cohort of mothers and infants, to provide insights into...

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

“…At family and community-level, stigma and fear of discrimination were frequently reported as factors associated with LTFUs, consistent with previous findings 10,12,[14][15][16][17][18]39 .This highlights the need to Household poverty characterized by food shortage was reported as an important factor associated with poor ART adherence and LTFU. This was consistent with previous findings in Malawi 21 and Mozambique 3 . This obviates the need for targeting social safety nets to HIV-affected families as a short-term solution and strengthening of economic empowerment programs as a long-term strategy.…”

“…Interestingly, both health care workers and the clients reported that clients disengaged from HIV care and sought alternative health care, which is consistent with findings from another study 21 Weaknesses in HIV service delivery characterized by poor staff attitude was cited as an important factor associated with LFTU. This was consistent with findings from previous studies 3,15,17,20,39,54 .…”

“…By 2016, the Ministry of Health estimated that 92% of HIV-positive pregnant women were initiated on ART 1 but only 74% of those women were retained in HIV care at 12 months postpartum 2 . Studies done elsewhere have documented similar rates of Loss-To-Follow-Up (LTFU) in HIV care [3][4][5][6][7][8][9] . LFTU breastfeeding mothers, who therefore are not adhering to ART, are at high risk of transmitting HIV to conducted in Mangochi and Salima districts, in Southern and Central Malawi, respectively.…”

Factors of Loss to Follow-up Antiretroviral Therapy in Islanded Area

“…The analysis showed no gender effect on loss to follow-up of antiretroviral therapy. This is not in accordance with research by Blanco et al (2015) that women have an effect on the loss to follow-up of antiretroviral therapy, a study by Govindasamy et al (2012) also stated that male sex is at risk of loss to follow-up, a study by Rice et al (2011) stated that women are at risk of loss to follow-up, and a study by Makunde et al (2012) stated that women are at greater risk of loss to follow-up of antiretroviral therapy.…”

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

“…By 2016, the Ministry of Health estimated that 92% of HIV-positive pregnant women were initiated on ART 1 but only 74% of those women were retained in HIV care at 12 months postpartum 2 . Studies done elsewhere have documented similar rates of Loss-To-Follow-Up (LTFU) in HIV care [3][4][5][6][7][8][9] . LFTU breastfeeding mothers, who therefore are not adhering to ART, are at high risk of transmitting HIV to cluster randomized trial compared the effectiveness of three service delivery models for retaining HIV-positive women and their HIV-exposed infants in HIV care.…”