Socio-demographic factors associated with loss to follow-up of HIV-infected women attending a private sector PMTCT program in Maharashtra, India

Abstract

Currently, 40% of HIV-infected women enrolled in national prevention of mother-to-child transmission (PMTCT) program in India are loss to follow-up (LTF) before they can receive single dose Nevirapine. To date no study from India has examined the reasons for inadequate utilization of PMTCT services. This study sought to examine the socio-demographic factors associated with LTF of HIV-infected women enrolled during 2002-2008 in a large-scale private sector PMTCT program in Maharashtra, India. Data on HIV-infected women who were enrolled during pregnancy (N=734) and who reported live birth (N=770) were used to analyze factors associated with LTF before delivery and after delivery, respectively. Univariate and multivariate analyses were conducted to estimate the associations between being LTF and socio-demographic factors using generalized linear models. Eighty (10.9%) women were LTF before delivery and 151 (19.6%) women were LTF after delivery. Women with less than graduate level education (RR = 6.32), from a poor family (RR = 1.61), who were registered after 20 weeks of pregnancy (RR = 2.02) and whose partners were HIV non-infected or with unknown HIV status (RR = 2.69) were more likely to be LTF before delivery. Similarly, the significant factors for LTF after delivery were less than graduate level education (RR = 1.82), poor family (RR = 1.42), and registration after 20 weeks of pregnancy (RR = 1.75). This study highlights the need for innovative and effective counseling techniques for less educated women, economic empowerment of women, better strategies to increase uptake of partner's HIV testing, and early registration of women in the program for preventing LTF in PMTCT programs. This need for innovative counseling techniques is even greater for PMTCT programs in the public health sector as the women accessing care in the public sector are likely to be less educated and economically more deprived.

Lost to follow-up among pregnant women in a multi-site community based maternal and newborn health registry: a prospective study

“…In most countries, the percentage of mothers who attend at least one ANC clinic is high but subsequent appointments are often not kept. Furthermore, about 20% of women who attend ANC in sub-Saharan Africa and south Asia do not seek skilled birth attendance [14]. This high rate of drop-out from the professional health care system, especially at the point of delivery, is consistent with the findings of this community registry study.…”

Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study

“…Access to services and provision of a complete cascade of services to pregnant women for prevention of mother-to-child transmission of HIV remains a major challenge in India [13]. Thus without effective interventions, mother-to-child transmission of HIV will continue.…”

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

“…Overall, these individual- and facility-level barriers result in decreased retention among women and infants throughout the PMTCT cascade [16,17], with only 66% of HIV-positive pregnant women receiving ART and 49% of infants receiving virologic diagnostic testing within the first two months of life in 2014 [18]. Understanding how these barriers impact retention among women and infants at varying time intervals along the PMTCT cascade may contribute to optimizing the performance of PMTCT programmes and identifying innovations to facilitate further improvement in the provision of care.…”