Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: A retrospective study

Abstract

Background Loss to follow-up (LTFU) deprives HIV-exposed infants the lifesaving care required and results in exposing HIV free infants to virus requisition risk. We aimed to determine the rate of LTFU, postnatal mother-to-child HIV-transmission and to identify maternal factors associated with LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral Hospital PMTCT clinic. Methods Study participants were infants born to HIV-positive mothers enrolled in the PMTCT clinic for HIV care at Mbarara Regional Referral Hospital. While access database in the Early Infant Diagnosis (EID) clinic provided data on infants, the open medical record system database at the ISS clinic provided that for mothers. Infants were classified as LTFU if they had not complete their follow-up schedule by 18 months of age. At 18 months, an infant is expected to receive a rapid diagnostic test before being discharged from the PMTCT clinic. Postnatal MTCT of HIV was calculated as a proportion of infants followed and tested from birth to 18 months of age. Logistic regression was used to determine possible associations between mothers’ characteristics and LTFU. In-depth interviews of mothers of LTFU infants and health workers who attend to the HIV-exposed infants were carried out to identify factors not captured in the electronic database. Results Out of 1624 infants enrolled at the clinic, 533 (33%) were dropped for lack of mother’s clinic identification number, 18 (1.1%) were either dead or transferred out. Out of 1073 infants analysed, 515 (48%) were LTFU while out of the 558 who completed their follow-up schedule, 20 (3.6%) tested positive for HIV. Young age of mother, far distance to hospital and non-use of family planning were identified as outstanding factors responsible for LTFU. In addition, in-depth interviews revealed facility-level factors such as “waiting time”. Conclusion This study has revealed a high rate of LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral hospital PMTCT clinic. Young maternal age, long distance to health facility and failure to use family planning were significantly associated with LTFU. Incorporating family planning services in the ART and PMTCT clinics could reduce LTFU of these infants.

High Incidence and Predictors of Loss to follow-up among children and adolescents on Life Long Antiretroviral therapy in the conflict-affected Northwest and Southwest Regions of Cameroon: A Retrospective cohort study

“…Our nding is similar to systematic study reported from Asia-Paci c, Central, East, West, and Southern Africa, the Caribbean and Central and South America [13] where rural settings (asHR 1.21, 95% CI 1.13 to 1.29) risk of LTFU. Another study shows no signi cant difference in the outcome of children in the rural and urban settings [14].…”

“…Different de nitions of LTFU carry the inherent risk of misclassi cation of active patients as LTFU. Some studies cite absence of 1 week from a scheduled appointment [13], absence of 2 weeks after an appointment date [14], while other use 6 weeks of missed appointment [15]. We employed the WHO de nition of LTFU as more than 90 days absence from the missed clinical or drug pick-up appointment without any follow up visit [16], a de nition also used by MINISANTE Cameroon.…”

Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil

“…Other surveillance services that investigated children exposed to HIV for 18 months showed that the loss to follow-up ranged from 20.8 [ 39 ] to 66.1% [ 40 ]. In a recent study that analyzed the follow-up of children exposed to HIV at a referral hospital in Uganda, the percentage of lost to follow-up was 48% in 18 months [ 4 ].…”

“…In 2020 85% [63%–98%] of pregnant women living with HIV had access to antiretroviral drugs to prevent transmission of HIV to their children [ 3 ]. This percentage, however, varies according to the weaknesses related to prenatal and postnatal care of health systems, especially in developing countries [ 4 – 6 ].…”

Lost to Follow-up and Predictors Among HIV-Exposed Infants in Northwest Ethiopia

“…In 2012, about 100,624 patients (18%) were lost to follow-up and therefore missed the opportunity of benefiting from ART care and support [ 12 ]. Other studies also reported that in Cameroon 47.37% and in Uganda 48% of infants were lost to follow-up [ 13 , 14 ].…”