Adherence to HIV care after pregnancy among mothers enrolled on the optionb+ program at Kisenyi HCIV: a retrospective cohort study

Abstract

Introduction: In Sub Saharan Africa, new HIV infections among women of reproductive age and deliveries to HIV positive mothers were 570,000 and 1,200,000 respectively in 2014. HIV positive mothers risk transmitting HIV to their children. To improve health outcomes of mothers and their babies, WHO adopted option B+ strategy which requires that all HIV-infected mothers irrespective of their CD4 count be initiated on ART for life. Life after pregnancy presents multiple factors which may be potential barriers to adherence to HIV care including; caring for a newborn, worries around delivering a healthy baby are in the past and mothers with high CD4 levels may not have experienced AIDS related conditions and do not perceive themselves as sick. Nonadherent ART mothers experience treatment interruptions placing them at substantial risk for drug resistance and virological failure. Objective: The purpose of this study was to determine the magnitude of adherence to HIV care after pregnancy among mothers enrolled on ART based Option B+. Methods: The study was a retrospective cohort with a qualitative component conducted among Option B+ mothers enrolled at Kisenyi HCIV a primary health care unit in Uganda. Quantitative data were analyzed using cox and modified poison models while for qualitative we used content analysis. Results: Out of 452 mothers, 131 (29%) were LTFU (95% CI 24.9 – 33.3) and 77.6% kept at least 80% of their scheduled appointments (95% CI 73.6- 81.3). The incidence of LTFU was 10.51 per 100 person years of observation time with median follow-up of 28.4 months. Appointment keeping was associated with unknown HIV status of exposed infant (PR=0.78, P<0.001) while LTFU was associated with tested positive and initiated ART at a later date (HR=0.49, P 0.024). The major reasons cited for adherence to HIV care after pregnancy included disclosure, exposed infant status and partner support, Conclusion: Adherence to HIV care after pregnancy is still poor among option B+ mothers. ART initiation on the day when a mother tests positive increases the risk of LTFU. Option B+ programs should give mothers ample time between the day they test positive and ART initiation and adopt deliberate strategies that promote disclosure especially to sexual partners.