Retention of mothers and infants in the prevention of mother‐to‐child transmission of HIV programme is associated with individual and facility‐level factors in Rwanda

Abstract

ObjectivesInvestigate levels of retention at specified time periods along the prevention of mother-to-child transmission (PMTCT) cascade among mother-infant pairs as well as individual- and facility-level factors associated with retention.MethodsA retrospective cohort of HIV-positive pregnant women and their infants attending five health centres from November 2010 to February 2012 in the Option B programme in Rwanda was established. Data were collected from several health registers and patient follow-up files. Additionally, informant interviews were conducted to ascertain health facility characteristics. Generalized estimating equation methods and modelling were utilized to estimate the number of mothers attending each antenatal care visit and assess factors associated with retention.ResultsData from 457 pregnant women and 462 infants were collected at five different health centres (three urban and two rural facilities). Retention at 30 days after registration and retention at 6 weeks, 3, 6, 9 and 12 months post-delivery were analyzed. Based on an analytical sample of 348, we found that 58% of women and 81% of infants were retained in care within the same health facility at 12 months post-delivery, respectively. However, for mother-infant paired mothers, retention at 12 months was 74% and 79% for their infants. Loss to facility occurred early, with 26% to 33% being lost within 30 days post-registration. In a multivariable model retention was associated with being married, adjusted relative risk (ARR): 1.26, (95% confidence intervals: 1.11, 1.43); antiretroviral therapy eligible, ARR: 1.39, (1.12, 1.73) and CD4 count per 50 mm3, ARR: 1.02, (1.01, 1.03).ConclusionsThese findings demonstrate varying retention levels among mother-infant pairs along the PMTCT cascade in addition to potential determinants of retention to such programmes. Unmarried, apparently healthy, HIV-positive pregnant women need additional support for programme retention. With the significantly increased workload resulting from lifelong antiretroviral treatment for all HIV-positive pregnant women, strategies need to be developed to identify, provide support and trace these women at risk of loss to follow-up. This study provides further evidence for the need for such a targeted supportive approach.

Incidence and Predictors of Loss-to-follow-up Among Pregnant and Breastfeeding Women on Option B+ PMTCT Program in Northwest Ethiopia: a Retrospective Follow-up Study.

“…Among these measures, increasing trained human power including midwives, frequent follow-up schedule and better drug preparation ( xed dose ART treatment) by giving better consideration for mothers to implement the program effectively (40). The current study nding is also lower than studies conducted in different African countries such as Uganda (15,16,18), South Africa(24), Malawi (14,46) and Kenya (19).This discrepancy might be due to the difference in study time, operational de nition of the outcome variable, and characteristic of study participants. For example, the study period for a study conducted in Malawi was 3-years record review (14) whereas the current study incorporated recent years' data which had better improvement ART coverage.…”

“…Reports from Africa indicated that, maternal age less than 25 years (12,13,15,21,26,27,32), less than 26 years (33), and less than 30 (23) were statistically signi cant positive predictor for LTFU. Moreover, Educational status (15,28), Marital status (19), unemployment status (34), number of pregnancies (13), religious reasons, and partner HIV status (12,16) were a signi cant predictor for LTFU. In addition, studies showed that the baseline low CD4 cell counts and high viral load measurement were positively associated with LTFU among women in PMTCT services (36,37).…”

“…Another retrospective cohort study in Myanmar showed that pregnant women's LTFU rate was 7 per 1000 person-years under option B+ PMTCT programs (11). A retrospective follow-up study in different African countries showed that the incidence of LTFU among pregnant and lactating mothers under option B+ program were still high which ranges from 16% to 53.7 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Previous studies in Ethiopia showed that the rate of LTFU among women under Option B+ program varied region to region.…”

Male Partners Involvement in Prevention of Mother-to-Child Transmission of HIV Services in Southern Central Ethiopia: In Case of Lemo District, Hadiya Zone

“…Beyond this HIV/AIDS mainly affects people of reproductive age and increasingly affects women whose newborn babies will be victims of the disease [9]. Consequently, maximum efforts to improve programs for prevention of mother-to-child transmission (PMTCT) of HIV have been focused primarily at the health facility level on defining an effective set of community interventions to increase demand and uptake of services and retention [10]. Among communities male partners have greater roles but their participation is low in PMTCT [11].…”

Lessons learned and study results from HIVCore: an HIV implementation science initiative

“…'s study of PMTCT clients in Rwanda found that unmarried, apparently healthy (i.e. ART ineligible), and women with higher CD4 counts at enrolment were at the greatest risk of LTFU in the sites they studied [18]. In Mozambique, men and women who enrolled early in HIV care said that the main reason for obtaining an HIV test – and for enrolling in HIV care – was the presence of signs or symptoms of sickness [19].…”