Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

Abstract

Background In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated to be 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced and interviewed 19 LTFU women. In addition, we interviewed 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed, translated and then analysed using deductive content analysis. Results The following reasons were reported as contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; poverty; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system levels, which contribute to poor retention of mother-infant pairs in HIV care. Key words PRIME, PMTCT, loss to follow up, mother-infant pairs, retention, Option B+

Receipt of infant HIV DNA PCR test results is associated with a reduction in retention of HIV-exposed infants in integrated HIV care and healthcare services: a quantitative sub-study nested within a cluster randomised trial in rural Malawi

“…However, mothers who commenced ART prior to enrolment had higher infant and maternal retention than those who commenced ART during pregnancy which may suggest these mothers may have had advanced appreciation and/ or understanding of the benefits of ART/adherence to healthcare services due to previous experience. Conversely, married women had a 60% increased hazard of non-retention compared with single women, suggesting a non-supportive husband or family environment may contribute to reduced maternal retention, consistent with a previous MTCT study in Malawi, [31] and a qualitative study nested within the PRIME study of HIVinfected mothers and health care providers [32].…”

“…While receiving an infant's HIV test result was associated with reduced infant retention, consistent with other studies, [12][13][14] no association was found with maternal retention. Conversely, the qualitative study nested in the PRIME study found receiving an infant's HIV negative test result was reported as being a contributing factor for maternal non-retention to HIV care, despite receiving counselling of the importance of adherence to sustained HIV care [32].…”

COVID-19 may Exacerbate the Clinical, Structural and Psychological Barriers to Retention in Care Among Women Living with HIV in Rural and Peri-Urban Settings in Uganda

“…Under the option B+, women diagnosed during pregnancy or breastfeeding are immediately initiated on ART irrespective of CD4 count or clinical staging, which makes them likely to miss out on key initiation procedures such as psychological preparation, an essential aspect in retention in care [12,13]. Women under option B + are likely not to be well counselled and tend to suffer from stigma related challenges including lack of disclosure [8,10]. This concern has been reported to be a hindrance to the success of Option B + and the Test and Treat strategies where, clients initiated under these programs possess a higher possibility of dropping out of care as they perceive themselves as healthy compared with those initiated under the conventional WHO staging criteria [8,13,19,20].…”

“…Women under option B + are likely not to be well counselled and tend to suffer from stigma related challenges including lack of disclosure [8,10]. This concern has been reported to be a hindrance to the success of Option B + and the Test and Treat strategies where, clients initiated under these programs possess a higher possibility of dropping out of care as they perceive themselves as healthy compared with those initiated under the conventional WHO staging criteria [8,13,19,20]. These ndings highlight a critical need for adequate preparation of women initiated on ART under option B+.…”

“…HIV stigma, disclosure and poor family support) barriers [7]. These barriers tend to be similar across the African region as presented in published literature [7][8][9][10][11]. Similar to the test and treat approach, the Option B + requires women to immediately initiate lifelong ART at diagnosis.…”