Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa

Kalembo, Fatch Welcome; Zgambo, Maggie

doi:10.5402/2012/589817

Cited by 70 publications

(77 citation statements)

References 51 publications

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“…This was attributed to the fear of domestic violence after disclosing their status to their spouses. Some quantitative studies have shown this to be true [18].…”

Section: Advances In Public Healthmentioning

confidence: 99%

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

Kweyamba

Buregyeya

Kusiima

et al. 2018

Advances in Public Health

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Background. Mother-to-Child Transmission of HIV accounts for more than 90% of all pediatric HIV infections. However, Prevention of Mother-to-Child Transmission (PMTCT) of HIV through provision of lifelong ART to HIV positive mothers faces various challenges which affect its success. One of such challenges is the loss to follow-up (LTFU) of mothers. Methodology. We conducted a cross-sectional study utilizing both quantitative and qualitative data collection methods. We were able to trace 279 HIV positive, pregnant, and lactating mothers among mothers who were initiated on lifelong ART for PMTCT in public health facilities in Ntungamo district, Western Uganda. The proportion of those who were lost to follow-up was determined, and Log binomial regression with stepwise backward elimination method was employed to identify factors associated with LTFU. Focus group discussions (FDGs) of women on lifelong ART and key informant interviews (KIIs) of peer educators were also performed. Results. Out of the 279 mothers that were successfully traced and interviewed, 103 (37%) were identified as lost to follow-up. The prevalence of LTFU was higher among those whose transport costs were above $2.75, adj (adjusted) PR (Prevalence Ratio) 1.6 (95% CI; 1.02-2.55); those who waited beyond one hour before being attended to, adj PR 1.74 (95% CI; 1.02-2.96); and those who assumed that their infant was already infected, adj PR 1.76 (95% CI; 1.15-2.70). On interviews, LTFU in these mothers was attributed to fear of swallowing antiretroviral drugs, HIV related stigma and discrimination, inadequate facilitation of the peer educators, long patient waiting time, and transportation to the health facilities. Conclusion. More than one-third of mothers initiated on lifelong ART for PMTCT in Ntungamo district were lost to follow-up over a period of 25 months. Recommendations. Provision of regular and adequate pre-ART and ART adherence counseling and provision of routine health education would reduce LTFU.

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“…This was attributed to the fear of domestic violence after disclosing their status to their spouses. Some quantitative studies have shown this to be true [18].…”

Section: Advances In Public Healthmentioning

confidence: 99%

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

Kweyamba

Buregyeya

Kusiima

et al. 2018

Advances in Public Health

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“…Additionally in children <5 years, severe immunodeficiency was documented in 56–64 % of children initiating antiretroviral therapy in resource-limited settings compared with 22 % in the USA (Koller et al 2015). Apart from late treatment initiation, retention of HIV-exposed children in care is low, with high loss to follow-up (19–89 %) at various points in the diagnostic and treatment cascade (Kalembo and Zgambo 2012). In India 63 % of HIV exposed infants were lost to follow-up after 1 year (Kumar et al 2015).…”

Section: Methodsmentioning

confidence: 99%

“…non-disclosure of HIV positive status and weak systems for social support resulting in poor retention in care and low adherence to treatment : Reasons for loss to follow-up are protean but included fear, stigma, home deliveries, low socio-economic status and lack of transport to access health facilities (Kalembo and Zgambo 2012). Non-disclosure of HIV positive status has also been associated with poor adherence (O’Malley et al 2015).…”

Section: Methodsmentioning

confidence: 99%

Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings

Goga

Singh

et al. 2016

Matern Child Health J

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Introduction Increasing access to HIV-related care and treatment for children aged 0–18 years in resource-limited settings is an urgent global priority. In 2011–2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients. Discussion and Conclusion We propose that this package of facility, community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.

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“…While the rates of uptake of tasks to PMTCT are known, it is difficult to estimate how many new MLH transition to HIV care post birth. In trials evaluating PMTCT the loss to follow-up ranges from 19% to 89% [5]. Loss to follow-up among adults in Johannesburg indicate that 30% are disengaged from care by 12 months [6].…”

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confidence: 99%

Re-engagement in HIV care among mothers living with HIV in South Africa over 36 months post-birth

Tomlinson

Scheffler

et al. 2015

Aids

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Summary PMTCT services are integrated into antenatal care in South Africa, but post-birth care is at HIV clinics. Almost all Mothers Living with HIV (MLH) in 24 township neighborhoods (N=324) reported engagement in HIV care from pregnancy to 36 months post-birth. Less than half re-engaged in HIV care at 6 months (45%), 52.5% at 18 months, and 62.5% at 36 months. Most were prescribed ARVs if reengaged in care, yet only about half (53%) are on ARVs at 36 months post birth. Implementation of Option B+ will require substantially better engagement in care.

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Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa

Cited by 70 publications

References 51 publications

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings

Re-engagement in HIV care among mothers living with HIV in South Africa over 36 months post-birth

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