Missed Opportunities for eMTCT Among Mothers Living with HIV whose Infants Sero-Converted in Masaka Regional Referral Hospital, Uganda.

Abstract

Globally, there was an estimated 36.7 million people living with HIV including 1.8 million children in the AVERT 2017 report. The UNAIDS 2020 report showed 400 new HIV infections daily among children below 15 years with the main mode of transmission being Mother to Child Transmission. Approximately 80% of these children are in Sub-Saharan Africa. According to UDHS 2016, mother-to-child transmission accounted for 18% of all new HIV infections. In 2018, Uganda registered a case rate of 466 new paediatric infections per 100,000 live births which is above the elimination target of < 50 new paediatric infections per 100,000 live births. The purpose of this study was to identify missed opportunities for eMTCT in Masaka Regional Referral Hospital. Methods This was a convergent parallel mixed methods study at Masaka Regional Referral Hospital. Records of mothers living with HIV from the Mother Baby Care Point were reviewed. Interviews were conducted for purposively sampled mothers and health care workers. The quantitative data were analysed using STATA version 17 and MS Excel professional Plus 2021. The qualitative data will be analysed using ATLAS.ti version 9 by thematic analysis using themes from the Capability, Opportunity, Motivation and Behaviour (COM-B) framework. Results cohort of 2020 analysed had the highest age group as 30-39 years at 49.8%. The age group of 20-29 years had the highest number of HIV positive infants (80%). During preconception, there 78% known HIV status, 100% on ART, 84% viral load coverage and 96% viral suppression. The antenatal period had 96% known HIV status, 94% on ART, 82% viral load coverage and 96% viral suppression. The labour and delivery period had 93% known HIV status and 99.9% on ART. Breastfeeding period had 100%known HIV status, 100% on ART, 87% viral load coverage and 96% viral suppression.

The facilitators of eMTCT were: - Capability facilitators – knowledge of eMTCT, delivery from health facility, and ANC attendance. Opportunity facilitators – availability of peer leaders, male partner engagement. Motivation facilitators – sensitization of mothers, drug adherence, refresher trainings for staff and adherence to eMTCT guidelines. The barriers of eMTCT were: - Capability barriers – frequent change of guidelines, lack of knowledge on eMTCT among the mothers, Opportunity barriers – stock out of medicines, gender-based violence, and stigma. Motivation barriers - non-disclosure to spouse, fear to disclose pregnancy. Conclusion This study found the missed opportunities for eMTCT at Masaka RRH as unknown HIV status, unknown ART status, Sub-optimal viral load coverage, non-attendance of ANC, poor male partner engagement, poor appointment keeping and non-disclosure to spouse across the various staged in the eMTCT continuum of care. The facilitators of eMTCT were knowledge of eMTCT, disclosure to spouse, ANC attendance, facility delivery, drug adherence and adherence to the eMTCT guidelines. The barriers of eMTCT were poor knowledge of eMTCT among the mothers, unskilled birth attendance, unknown HIV status, Stigma, gender-based violence and non-disclosure to spouse.