Retention and its Determinants among HIV Infected Pregnant Women Enrolled on Elimination of Mother-To-Child Transmission Care in Six Public Health Facilities in Kampala: A Retrospective Cohort Study

Abstract

Introduction: The Option B+ strategy for EMTCT recommends maternal lifelong triple ART once HIV diagnosis is made. It has advantages and was rolled out to health facilities as MoH policy. Whereas Uganda has invested in this strategy, studies show that retention on this program is poor in Sub-Saharan Africa (SSA) and is influenced by several factors. There’s a paucity of data on the determinants of retention among mothers on the Option B+ program in Uganda’s urban settings. This study determines one-year retention rates and describes the individual, health system and community factors influencing maternal retention on the Option B+ program within six urban health centers in Kampala. Methodology: A retrospective cohort study was conducted through a review of records of 862 HIV positive mothers enrolled into Option B+ EMTCT care in 2015. Structured questionnaireguided interviews with health care workers, community leaders, mothers on EMTCT care programs, and their care takers were conducted to qualitatively assess for the determinants of retention in care. Statistical logistic regression models and deductive thematic content analyses were used to determine and describe the variables associated with maternal retention on Option B+ EMTCT care. Results: The 12-month maternal retention on Option B+ care was 53.6% across the six health facilities. Religion, marital status, gestational age and WHO stage at enrolment determined retention in care. Catholics had almost 3 times the odds of being in care compared to the Born Again Christian (OR, 95% CI: 2.84, 2.01-4.02), p<0.001) and being a Moslem was protective of dropping out of care OR, 95% CI:1.4(1.01-2.06, p=0.045). The never married and those who had separated/divorced/widowed were more likely to drop out of care compared to married women (OR, 95%CI: 0.68, 0.47-0.98, p=0.039 and 0.56, 0.33-0.97, p=0.037) respectively. Women who came in their 2nd trimester were more likely to stay in care compared to those who came in their 1 st trimester (OR, 95%CI, 1.73, 1.06-2.80, P=0.027). Mothers enrolled at WHO stage 2&3 were more likely to stay in care compared to those who were at stage 1 (OR, 95%CI, 1.98, 1.01-3.87, P=0.046). Conclusion: Within the six KCCA public health facilities, twelve-month maternal retention on Option B+ PMTCT care programs is poor. It is significantly determined by religion, marital status, gestational age and WHO stage at enrolment. Recommendation: In order to ensure continuous engagement of mothers in EMTCT care, HIV care programs have to support health system and community interventions that address retention barriers at various levels