Vulnerable at Each Step in the PMTCT Care Cascade: High Loss to Follow Up During Pregnancy and the Postpartum Period in Tanzania

Abstract

Objective: In 2013, Tanzania adopted the World Health Organization's Option B+ guidelines for prevention of mother-to-child transmission of HIV (PMTCT), whereby all HIV-infected pregnant women initiate lifelong antiretroviral therapy. This study examined retention in PMTCT across critical junctures in the care continuum.Methods: This was a retrospective study of patient-level data for a cohort of women enrolled in PMTCT during the first year of Option B+ in Tanzania. Retention in care was described across three periods: (1) the first month of antenatal care (ANC), (2) pregnancy, and (3) the postpartum period. Logistic regression was used to identify factors associated with loss to follow up (LTFU) during the first month of ANC. Survival analyses were used to identify factors associated with LTFU during pregnancy and the postpartum periods.Results: 650 participants were included in the cohort; 262 (40.3%) were newly diagnosed with HIV. Two years after delivery, 383/650 (58.7%) were LTFU. Of the 383 LTFU, 73 (19.1%) were lost during the first month of ANC, 44 (11.5%) during pregnancy, and 266 (69.5%) after delivery.

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

“…Hence, initiating ART on the same day with HIV diagnosis or under the "test and treat" approach increases the risk of LTFU from the program [27,28]. The risk of LTFU among women who were newly diagnosed with HIV was consistently higher than women who were previously diagnosed with HIV [25,29,30].…”

Barriers and facilitators of completing the steps in the PMTCT cascade at Midwife Obstetric Units in Gauteng - Healthcare Provider and Patient's views

“…Mostly, the clinics struggle to trace patients after delivery due to wrong addresses. This was confirmed in another study whereby travel was three times more common after delivery than before delivery (18,23,24). Both healthcare providers and patients also agreed that HIV disclosure facilitates care by allowing for family support (16,17,25).…”

“…In another study, it was reported that women who had a new HIV diagnosis were more likely to be loss to follow up than women with an established HIV diagnosis (17,18). This shows that intensive counselling and support system is of importance during ANC.…”

“…Nurses faces the challenges of providing intensive counselling to patients after delivery due to limitation of space and staff shortages as a results, women don't get enough time to process information after delivery. Other studies mentioned that women are non-adherent after delivery due to stigma, fear of spouses, lack of disclosure and side-effects (9,16,18,20,23) and the reason may be that women are initiated ART on the same day of diagnosis (18).…”

Retired Nurses Can Improve Retention in Prevention of Mother-to-Child Transmission Programmes

“…34 A recent study of retention in care during the first year of the B+ programme in Tanzania found that 2 years after enrolment into the B+ programme, 59% of women were LTFU, and nearly one-third of those lost, were lost during pregnancy. 35 A qualitative study carried out among women referred for life-long antiretroviral therapy from the ComTru study indicated that among the main deterrents from reporting were fear of stigmatisation and conflicts with work resulting from frequent clinic visits and potentially resulting in loss of income. These deterrents have also been found to affect clinic attendance among women receiving option B+ in South Africa.…”