Unpacking Loss to Follow-Up Among HIV-Infected Women Initiated on Option B+ In Northern Tanzania: A Retrospective Chart Review

Mazuguni, Festo; Mwaikugile, Boaz; Cichowitz, Cody; Watt, Melissa H.; Mwanamsangu, Amasha; Mmbaga, Blandina T.; Njau, Prosper; Mahande, Michael Johnson; Todd, Jim; Renju, Jenny

doi:10.24248/eahrj.v3i1.593

Cited by 7 publications

(16 citation statements)

References 21 publications

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“…[25, 26] The study conducted Kilimanjaro region on the predictors of postpartum HIV care engagement among women in the PMTCT program, suggested strengthening the social support network system by engaging treatment supporters in HIV care. [13, 16, 18, 27, 28] Therefore, findings from this study cement the importance of engaging treatment supporters not only in engaging mothers to care but also to ensure that their babies receive the…”

Section: Discussionmentioning

confidence: 74%

“…The finding is consistent with findings of past studies in Northern Tanzania, which revealed a high loss to follow-up after the first two months post-delivery as one of the setbacks in the implementation of Option B+. [15, 16] Does this have to do with insufficient knowledge about the Option B+ cascade of services until after 18 months? Probably they thought that the DBS-PCR 1 test results were confirmatory and there was no need for another test.…”

Section: Discussionmentioning

confidence: 99%

“…Poor adherence among mothers enrolled in Option B+ has been found to be associated with a lack of experience with PMTCT services, short time to process and accept results, denial of the test results, fear of committing to a life-long treatment regimen, feeling of shame, and stigma. [16, 18]…”

Section: Discussionmentioning

confidence: 99%

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Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test

Morris

Nyamhagata

Tarimo

et al. 2022

Preprint

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Background Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test at the 18th month. However, most mothers enrolled in the PMTCT-option B+ cascade of services in Tanzania do not turn-up for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for confirmatory HIV testing 18 months post-delivery in Tanzania. Methods This study utilized longitudinal data collected between 2015 and 2017 from 751 mother-baby pairs enrolled in the PMTCT- Option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Analysis was conducted using descriptive statistics to characterize the proportion of mother-baby pairs turning up for a confirmatory test and logistic regression analysis to examine factors associated with turning up for a confirmatory HIV testing at the 18th month. Results A total of 751 mother-baby records were observed only and 44.2% (95% CI: 40.7 – 47.8) of them received the HIV confirmatory test at 18 months. Mothers aged 25 years or above (adults’ mothers) were 1.44 more likely to turn up for confirmatory HIV-testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV-testing compared with partners not tested for HIV; newly HIV-positive mothers diagnosed on enrolment were 28% less likely to turn up their babies for confirmatory HIV-testing compared to known HIV-positive mothers; mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one, and mothers with babies whose DBS-PCR-1 was collected were 3.61 more likely to have confirmatory HIV-testing than those who didn’t collect DBS-PCR-1. Conclusion This study reveals that the turn-up for confirmatory HIV testing at 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This turn-up is associated with low maternal age, having a male partner who has not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the first DBS-PCR HIV test within the first two months post-delivery.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test

Morris

Nyamhagata

Tarimo

et al. 2022

Preprint

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“…1 Tanzania adopted Option B+ in 2013, and studies have demonstrated subsequent increases in the rates of HIV diagnosis and linkage to care. 2 , 3 However, a meta-analysis of studies in Africa showed that retention in PMTCT care is lower than in the general population of people living with HIV (PLWH), threatening the effectiveness of PMTCT programs and the goals of the Option B+ protocol. 4 Multiple studies conducted in East Africa have identified HIV stigma as a primary factor influencing retention in PMTCT care.…”

Section: Introductionmentioning

confidence: 99%

“…1 Tanzania adopted Option B+ in 2013, and studies have demonstrated subsequent increases in the rates of HIV diagnosis and linkage to care. 2,3 However, a meta-analysis of studies in Africa showed that retention in PMTCT care is lower than in the general population of people living with HIV (PLWH), Stigma impacts retention to PMTCT in a variety of ways. 5 During pregnancy and the postpartum period, WLHIV in Tanzania describe feeling uniquely vulnerable to stigma, particularly in the form of fear of abandonment or mistreatment by their partner or the loss of other key social supports.…”

mentioning

confidence: 99%

HIV Community-Level Stigmatizing Attitudes in Tanzania: Perspectives from Antenatal Care

Sao

Knettel

Kisigo

et al. 2020

EAHRJ

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Introduction: Stigma significantly impacts retention in HIV care and quality of life among people living with HIV. This study explored community-level HIV stigma from the perspective of patients and healthcare workers in antenatal care (ANC) in Moshi, Tanzania. Methods: We conducted in-depth interviews with 32 women (20 living with HIV), key-informant interviews with 7 ANC clinic employees, and two focus group discussions with 13 community health workers. Results: Themes emerged related to drivers and manifestations of stigma, resilience to stigmatizing attitudes, and opportunities to address stigma in ANC. Drivers of stigma included a fear of infection through social contact and associations of HIV with physical weakness (e.g., death, sickness) and immoral behaviour (e.g., sexual promiscuity). Manifestations included gossip, physical and social isolation, and changes in intimate relationships. At the same time, participants identified people who were resilient to stigmatizing attitudes, most notably individuals who worked in healthcare, family members with relevant life experiences, and some supportive male partners. Conclusion/Recommendations: Supportive family members, partners, and healthcare workers can serve as role models for stigma-resilient behaviour through communication platforms and peer programs in ANC. Manifestations of HIV stigma show clear links to constructs of sexuality, gender, and masculinity, which may be particularly impactful during pregnancy care. The persistence of stigma emphasizes the need for innovation in addressing stigmatizing attitudes in the community. Campaigns and policies should go beyond dispelling myths about HIV transmission and immorality to innovate peer-led and couples-based stigma reduction programming in the ANC space

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Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania

Urrio,

Lyatuu,

Sando

et al. 2024

J Int AIDS Soc.

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IntroductionTo prevent vertical HIV transmission and ensure healthy mothers and children, pregnant women with HIV must remain on antiretroviral treatment (ART) for life. However, motivation to remain on ART may decline beyond the standard 2‐year breastfeeding/postpartum period. We assessed attrition and retention in ART care among women with HIV up to 6 years since enrolment in vertical transmission prevention services in Dar es Salaam, Tanzania.MethodsA prospective cohort of 22,631 pregnant women with HIV were enrolled in vertical transmission prevention services between January 2015 and December 2017 in routine healthcare settings and followed‐up to July 2021. Kaplan−Meier was used to estimate time to ART attrition (died, stopped ART or was lost to follow‐up [no show ≥90 days since scheduled appointment]) and the proportion retained in care. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) of ART attrition in relation to predictors.ResultsParticipants were followed‐up to 6 years for a median of 3 years (IQR: 0.1–4). The overall ART attrition rate was 13.8 per 100 person‐years (95% CI: 13.5–14.1), highest in the first year of enrolment at 27.1 (26.3–27.9), thereafter declined to 9.5 (8.9–10.1) in year 3 and 2.7 (2.1–3.5) in year 6. The proportion of women retained in care were 78%, 69%, 63%, 60%, 57% and 56% at 1, 2, 3, 4, 5 and 6 years, respectively. ART attrition was higher in young women aged <20 years (aHR 1.63, 95% CI: 1.38–1.92) as compared to 30‐39 year‐olds and women enrolled late in the third versus first trimester (aHR 1.29, 95% CI: 1.16–1.44). In contrast, attrition was lower in older women ≥40 years, women who initiated ART before versus during the index pregnancy and women attending higher‐level health facilities.ConclusionsART attrition among women with HIV remains highest in the first year of enrolment in vertical transmission prevention services and declines markedly following a transition to chronic HIV care. Targeted interventions to improve ART continuity among women with HIV during and beyond prevention of vertical transmission are vital to ending paediatric HIV and keeping women and children alive and healthy.

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Unpacking Loss to Follow-Up Among HIV-Infected Women Initiated on Option B+ In Northern Tanzania: A Retrospective Chart Review

Cited by 7 publications

References 21 publications

Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test

Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test

HIV Community-Level Stigmatizing Attitudes in Tanzania: Perspectives from Antenatal Care

Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania

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