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. 2018 Oct 24;18(1):533.
doi: 10.1186/s12879-018-3450-9.

Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study

George Kiwanuka  1 , Noah Kiwanuka  2 , Fiston Muneza  2 , Juliet Nabirye  3 , Frederick Oporia  4 , Magdalene A Odikro  2 , Barbara Castelnuovo  5 , Rhoda K Wanyenze  4
Affiliations

Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study

George Kiwanuka et al. BMC Infect Dis. .

Abstract

Background: Lifelong antiretroviral therapy for HIV infected pregnant and lactating women (Option B+) has been rapidly scaled up but there are concerns about poor retention of women initiating treatment. However, facility-based data could underestimate retention in the absence of measures to account for self-transfers to other facilities. We assessed retention-in-care among women on Option B+ in Uganda, using facility data and follow-up to ascertain transfers to other facilities.

Methods: In a 25-month retrospective cohort analysis of routine program data, women who initiated Option B+ between March 2013 and March 2015 were tracked and interviewed quantitatively and qualitatively (in-depth interviews). Kaplan Meier survival analysis was used to estimate time to loss-to-follow-up (LTFU) while multivariable Cox proportional hazards regression was applied to estimate the adjusted predictors of LTFU, based on facility data. Thematic analysis was done for qualitative data, using MAXQDA 12. Quantitative data were analyzed with STATA® 13.

Results: A total of 518 records were reviewed. The mean (SD) age was 26.4 (5.5) years, 289 women (55.6%) attended primary school, and 53% (276/518) had not disclosed their HIV status to their partners. At 25 months post-ART initiation, 278 (53.7%) were LTFU based on routine facility data, with mean time to LTFU of 15.6 months. Retention was 60.2 per 1000 months of observation (pmo) (95% CI: 55.9-64.3) at 12, and 46.3/1000pmo (95% CI: 42.0-50.5) at 25 months. Overall, 237 (55%) women were successfully tracked and interviewed and 43/118 (36.4%) of those who were classified as LTFU at facility level had self-transferred to another facility. The true 25 months post-ART initiation retention after tracking was 71.3% (169/237). Women < 25 years, aHR = 1.71 (95% CI: 1.28-2.30); those with no education, aHR = 5.55 (95% CI: 3.11-9.92), and those who had not disclosed their status to their partners, aHR = 1.59 (95% CI: 1.16-2.19) were more likely to be LTFU. Facilitators for Option B+ retention based on qualitative findings were adequate counselling, disclosure, and the desire to stay alive and raise HIV-free children. Drug side effects, inadequate counselling, stigma, and unsupportive spouses, were barriers to retention in care.

Conclusions: Retention under Option B+ is suboptimal and is under-estimated at health facility level. There is need to institute mechanisms for tracking of women across facilities. Retention could be enhanced through strategies to enhance disclosure to partners, targeting the uneducated, and those < 25 years.

Keywords: EMTCT; HIV; LTFU; Option B+; PMTCT; Retention.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval to conduct this study was granted by the Higher Degrees Research and Ethics Committee (HDREC) of the Makerere University School of Public Health and the Uganda National Council of Science and Technology (UNCST). Permission was also obtained from the District Health Officer (DHO). Routine service data was anonymized for analysis. Participants in the cross-sectional quantitative and qualitative interviews provided written informed consent prior to the interview.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Illustration of the study profile
Fig. 2
Fig. 2
Kaplan Meier for probability of retention over 25 months of follow up
Fig. 3
Fig. 3
Kaplan Meier showing retention estimates by disclosure status
See this image and copyright information in PMC

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References

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