Loss to follow up of mother-baby pairs in the prevention of mother-to child transmission of HIV care at Masaka regional referral hospital, Central Uganda.

Abstract

Introduction: In 2012, World Health Organization (WHO) recommended the provision of lifelong Antiretroviral Therapy (ART) at all Human Immunodeficiency Virus (HIV) infected pregnant and breastfeeding women regardless of their CD4 count and Antiretroviral drugs (ARV) prophylaxis for their infants up to six weeks post-partum as part of a strategy to eliminated Mother to Child Transmission (e-MTCT) of HIV. Uganda adopted the lifelong ART strategy in 2012. However, programmatic challenges remain in loss to follow up of mother-baby pairs in care. This study aimed to determine the rate and predictors of LTFU of HIV positive mothers and their exposed infants at Masaka regional referral hospital (RRH). Methods: A retrospective cohort study using routinely collected data was carried out at Masaka RRH in south central Uganda. Health facility records of 312 HIV-positive mother and their HIV exposed infants who were registered in the e-MTCT program between June 2014- June2016 were reviewed. Data was extracted using a pretested data abstraction form. Kaplan-Meier analysis was used to determine the rate of loss to follow-up in care. Cox-proportion hazards regression was used to estimate predictors of loss to follow-up. Reasons for LTFU were explored by performing in-depth interviews with 3 mothers were retained in care and 3 who were lost to follow-up. Results: The overall median follow-up time of mother-baby pairs was 16.5 months. Twenty two percent (22%) of the mother-baby pairs were lost to follow-up in care by the end of 18 months postpartum. The proportion of mother-baby pairs LTFU at 6, 12 and 18 months was 9%, 13% and 22%, respectively. The independent predictors of LTFU were; delivering from home, cessation of breastfeeding at 1stPCR and detectable viral load. Based on the in-depth interviews, reasons for loss to follow up included side-effects of drugs, difficulty in transportation to the facilities, long waiting times at the health facilities, concerns about stigma, lack of partner support, and domestic violence Conclusion: LTFU of mother-baby pairs 18 months postpartum at Masaka RRH was moderate. Delivering from home, cessation of breastfeeding by 1stPCR and having a detectable viral load were predictors of LTFU. Poor provider attitudes, long waiting time, stigma and discrimination, lack of partner support, transport difficulties are some of the reasons that increase the chances of LTFU in PMTCT. Recommendation: Health education with emphasis on remaining in care and building community networks through peer support would reduce LTFU of mother-baby pairs.