Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study

Abstract

Background: Loss to follow-up (LTFU) deprives HIV-exposed infants the lifesaving care required and results in exposing HIV free infants to virus requisition risk. We aimed to determine the rate of LTFU, postnatal mother-tochild HIV-transmission (MTCT) and to identify maternal factors associated with LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral Hospital PMTCT clinic. Methods: Study participants were infants born to HIV-positive mothers enrolled in the PMTCT clinic for HIV care at Mbarara Regional Referral Hospital. While access database in the Early Infant Diagnosis (EID) clinic provided data on infants, the open medical record system database at the ISS clinic provided that for mothers. Infants were classified as LTFU if they had not completed their follow-up schedule by 18 months of age. At 18 months, an infant is expected to receive a rapid diagnostic test before being discharged from the PMTCT clinic. Postnatal MTCT of HIV was calculated as a proportion of infants followed and tested from birth to 18 months of age. Logistic regression was used to determine possible associations between mothers' characteristics and LTFU. In-depth interviews of mothers of LTFU infants and health workers who attend to the HIV-exposed infants were carried out to identify factors not captured in the electronic database. Results: Out of 1624 infants enrolled at the clinic, 533 (33%) were dropped for lack of mother's clinic identification number, 18 (1.1%) were either dead or transferred out. Out of 1073 infants analysed, 515 (48%) were LTFU by 18 months of age while out of the 558 who completed their follow-up schedule, 20 (3.6%) tested positive for HIV. Young age of mother, far distance to hospital and non-use of family planning were identified as outstanding factors responsible for LTFU. In addition, in-depth interviews revealed facility-level factors such as "waiting time" which would not be found in routine client databases.

Good Utilization, Low Completion Rates of Early Infant HIV Diagnostic Services at a District Hospital in Rural South Western Uganda

“…Availability of test kits as a driver was contrary to the ndings of a study conducted in seven health centers in Uganda. (Kiyaga et al, 2018) A complex interplay between facility level and client-level barriers was revealed by our data as also shown in study by (Ankunda et al 2020).…”

Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit

“…Multivariate logistic regression analysis was undertaken to investigate factors associated with maternal LTFU before birth and the mean time before the infant was registered in a paediatric ART programme. Based on findings from previous research 24 and data available from this study, we selected variables that might influence the outcome of interest (maternal LTFU) to be included in the predictive models. For the analysis of factors associated with maternal LTFU before birth, we used Firth’s logistic regression 25 26 to account for bias due to rare event data, which are known to produce substantial bias estimates with conventional logistic regression.…”

Using adult care visits to diagnose HIV infection in children, Burkina Faso

“…The reasons for this situation include: child no longer living with their mother; mother’s unwillingness to have their child tested; approval needed from the father whom the mother was reluctant to ask; father’s refusal to allow their child to be tested; lack of money for transportation; and remoteness of the health facility. 28 The short study duration did not allow us to assess if some of these mothers could have overcome these difficulties and eventually had their child tested.…”