Low mother-to-child HIV transmission rate but high loss-to-follow-up among mothers and babies in Mandalay, Myanmar; a cohort study

Abstract

IntroductionLoss-to-follow-up (LTFU) throughout the Prevention of Mother-To-Child Transmission (PMTCT) cascade remains one of the major threats to the success of PMTCT programs. In this study, we aimed to determine the mother-to-child transmission rate in a programmatic setting and to determine factors associated with LTFU among enrolled mothers and unfavorable outcomes among HIV-exposed babies which includes being HIV positive, death and LTFU.MethodsA retrospective cohort study reviewing routinely collected data in an Integrated HIV care program, Mandalay, Myanmar in June 2016.LTFU means mother/infant missing appointed visit for more than three months.ResultsOf 678 pregnant women enrolled in PMTCT program between March 2011 and June 2014, one stillbirth and 607 live births were recorded in this cohort. Of 457 HIV-exposed babies with HIV-test recorded at the end of the intervention, nine (2%) were HIV-positive. Pregnant women’s and exposed-babies’ LTFU rate was 7 per 1000 person-years, and 10 per 1000 person-years respectively. PMTCT option B protocol was found to be significantly associate with maternal LTFU [adjusted Hazard Ratio (aHR) 95% CI: 3.52 (1.38–8.96)] when compare to mothers receiving option B+/lifelong antiretroviral therapy (ART). Weight <2.5 Kg at enrolment, receiving mixed-feeding, vaginal delivery and option B PMTCT protocol were significantly associated with unfavorable outcomes among exposed babies [aHR(95% CI): 5.40 (1.66–17.53), 5.91(1.68–20.84), 2.27 (1.22–4.22) and 2.33 (1.16–4.69) respectively].ConclusionMother-to-child HIV transmission rate in this public hospital-based program was lower than the 5% national target, which indicates a successful PMTCT intervention. However, a high proportion of HIV-infected mothers and exposed babies LTFU was recorded. Lifelong ART provision to HIV-positive pregnant women was shown to reduce exposed babies’ LTFU, death and transmission rate (unfavorable outcomes) in this setting. Lessons learned from this program could be used to inform policy and practice in the country, while the programmatic challenge of LTFU should be urgently addressed.

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 operational de nitions of studies in Kenya and south Africa (28,33) were missing 6 months till last follow up visits compared to three months to the current study. Furthermore, the rate of LTFU on the current study was lower than the study done in Myanmar which was 7 per 1000 person-years (11). This difference might be due to the reason that study in Myanmar included only pregnant women.…”

“…A prospective cohort study in Brazil showed that the rate of LTFU among mother-child pairs in PMTCT program was 15.4% (10). Another retrospective cohort study in Myanmar showed that pregnant women's LTFU rate was 7 per 1000 person-years under option B+ PMTCT programs (11). A retrospective follow-up study in different African countries showed that the incidence of LTFU among pregnant and lactating mothers under option B+ program were still high which ranges from 16% to 53.7 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”

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

“…The previous study was conducted when the program was initiated for the first time in the country, which might have increased the rate of LTFU due to lack of resources allocated including trained human power, to implement the program effectively. The finding is also lower than studies conducted in different countries such as Myanmar, Uganda, South Africa, Malawi and Kenya [12,14,[17][18][19]. These variations might be due to the differences in definitions of LTFU in different settings as indicated above.…”

“…Unfortunately, LTFU from Option B+ decreases women's access to HIV care and treatment, which leads to the advanced stage of HIV, increases maternal HIV/AIDSrelated morbidity and mortality, facilitates the vertical transmission of HIV to newborn and facilitates the development of drug resistance [10,14]. Even though Option B+ program has been implemented for the last 6 years, there are no studies and/or documented reports on the incidence of LTFU and its predictors among pregnant and lactating women on lifelong ART.…”

Access to prevention of mother‐to‐child transmission of HIV along HIV services cascade through integrated active case management in 15 operational districts in Cambodia

“…Moreover, cohort data collection, even on a subset of sites, has been recommended in order to get more reliable information and support in national data modelling systems . Since the introduction of option B+ a few studies have documented the PMTCT cascade indicators, and interventions contributing to improve retention and adherence to PMTCT programmes in sub‐Saharan Africa and in Asia . The present study aims to analyse key indicators of the PMTCT service cascade following the implementation of the IACM approach in the 15 ODs in order to inform the Ministry of Health and adapt PMTCT interventions towards achieving the EMTCT targets.…”