Factors associated with loss to follow up of HIV-exposed infants-caretaker pairs enrolled in the early infant diagnosis clinic: A case study of Lira Regional Referral Hospital

Abstract

Loss to follow up (LTFU) of HIV-exposed infants remains a major barrier to controlling HIV/AIDS in the Elimination of Mother To Child Transmission of HIV/Early Infant Diagnosis (EMTCT/EID) programmes in Uganda. Uganda’s Ministry of Health reported 60% Loss to Follow up (LTFP) of mother baby pairs in 2013 at 166 sites countrywide, however the extent and reasons for the LTFP in Lira District are unknown. Some studies have indicated that the northern region as a whole has an estimated LTFU of approximately 53%. This study aimed to assess the extent and factors associated with LTFU of HIV-exposed Infant- caretaker pairs enrolled in the EID clinic at Lira Regional Referral Hospital (LRRH) from January 2010 to June 2012 so as to guide policy formulation on curbing LTFU and ensuring of retention of mother baby pairs in EMTCT/EID care. A cross sectional study was conducted among 280 HIV-exposed infant- caretaker pairs who were randomly selected from the EID clinic register, traced and interviewed using a semi-structured questionnaire on key variables of predisposing, enabling and need factors associated with LTFU. At uni-variable and bi-variable analysis, independent variables with p values <=0.05 were selected for multivariable Logistic regression analysis. Adjusted Odds ratio was used to measure the strength of this association. The results indicated loss to follow up rates by 2nd PCR as 32.8% and 60% between the 2nd PCR and final rapid HIV test. The overall loss to follow up over the study period was 51.8%. At multivariable analysis levels, Belonging to a FSG; [Adjusted OR 0.477; CI. (0.268-0.847)] and between 2nd PCR & Final Rapid test [AOR0.461; CI0.260-0.817]; Having contact information at the Health Facility; AOR 0.350; CI [0.197-0.622] between 2nd PCR & final rapid test; AOR 0.332; CI [0.187-0.591] at overall LTFU; Delivery at health Facility AOR 0.263; CI [0.08-0.863] were associated with reduction in LTFU wheras if babies were perceived to be healthier AOR 3.807; CI[1.231-11.770] P-value 0.02 between 2nd PCR and final rapid test and AOR 4.750; CI [1.455-15.507], PV 0.010 at overall LTFU and younger maternal ages (18 to 24) than older maternal ages [AOR 2.851; CI 1.158-7.021] between 2nd PCR and final rapid test and AOR 2.762; CI [1.117-6.834 overall LTFU]. In conclusion, at Lira Regional Referral Hospital Early Infant Diagnosis clinic there is 51% overall Loss to follow up of infant mother pairs, but most noticeable between the 2nd PCR and final Rapid test at 60%, a clear indication that final HIV status of many HIV exposed babies are unknown hence impacting on care and treatment. The overall recommendation from the study for Lira Regional Referral Hospital is to revise community and EID clinic delivery of services. Empower & respond to the broader health & social needs of younger mothers, encourage them to enroll into family support groups to reduce stigma and support disclosure; as well as encourage all mothers in care to provide telephone contacts and physical addresses to ensure follow up for those defaulting. Sensitize community on relevance of continued testing and counseling even when the babies seem healthier and previous tests are negative. Synchronize the appointment dates of infant-caretaker pairs so as to minimize frequency of visits.