Adherence and associated factors to postnatal follow up in the program for the prevention of mother to child transimission of HIV at Mulago hospital
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TITTLE: Adherence and associated factors to postnatal follow up in the program for the prevention of mother to child transmission of HIV at mulago hospital. BACKGROUND: The scale up of the diagnosis of HIV in pregnancy through routine antenatal and intrapartum testing has gone along way in facilitating perinatal PMTCT interventions. Despite this, postnatal follow up of the mother and child for evaluation and ongoing HIV/AIDS care remains a challenge in developing countries. This study was designed to identify the level of adherence and factors associated with postnatal follow up in the PMTCT program at mulago hospital. METHODS: This was a cross-sectional study in which 289 HIV positive mothers were enrolled following discharge from mulago hospital postnatal wards. They were then followed up to six weeks postpartum. They were interviewed concerning socio-demographic characteristics and some possible factors that could be associated with adherence to postnatal follow up using a standardised questionnaire. The level of adherence to postnatal follow up was determined at six weeks postpartum. Four focus group discussions for qualitative analysis were conducted at the end of the follow up period to qualitatively assess the factors that motivate or hinder adherence. RESULTS: The level of adherence to postnatal follow up in the PMTCT program was found to be 38% (110/289) by the end of six weeks. At bivariate analysis, the following factors were associated with adherence to postnatal follow up: living with a partner, maternal age greater than 25 years, belonging to the Christian faith, multiparity, antenatal attendance, previous postnatal clinic attendance and knowledge of venue were to return, having one or no living child, being or having a close contact on HAART, having tested before labour, being already registered into an HIV/AIDS care program and having access to a cell phone. After adjusting for confounding factors, previous postnatal clinic attendance (OR 3.5, P 0.003, Christian faith (or 3.1, p 0.018) and having access to a phone (OR 3.1, P 0.003) remained significantly associated with adherence to postnatal follow up. These results were stratified for age to cater for interaction between maternal age and previous postnatal attendance. In the focus group discussions, lack of funds for transport and inability of the mothers to disclose their HIV positive serostatus to their spouses were identified as the major hindrances to adherence to postnatal follow up in the PMTCT program. CONCLUSIONS: In view of slightly over a third of the mothers who adhered to postnatal follow up, there is still a great need for more emphasis on the value of postnatal follow up and timely linkage to comprehensive care for mother and child beyond the better known peri partum PMTCT interventions. Mothers at increased risk for non adherence like the young prime para and those who have never attended PNC review require closer attention.