Factors associated with loss-to-follow-up of HIV-positive mothers and their infants enrolled in HIV care clinic: A qualitative study

S Mpinganjira,V Mwapasa,A Gunda,T Tchereni

doi:10.1186/s12889-020-8373-x

S Mpinganjira, V Mwapasa + Show 2 more

Open Access

https://doi.org/10.1186/s12889-020-8373-x

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Abstract

BackgroundIn Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated to be 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs.MethodsWe conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced and interviewed 19 LTFU women. In addition, we interviewed 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed, translated and then analysed using deductive content analysis.ResultsThe following reasons were reported as contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; poverty; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options.ConclusionOur study has found multiple factors at personal, family, community and health system levels, which contribute to poor retention of mother-infant pairs in HIV care.

Highlights

In Malawi, loss to follow-up (LTFU) of Human Immuno-deficiency Virus (HIV)-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated to be 74% at 12 months postpartum
Study design and study site This was a qualitative sub-study nested within the Promoting Retention among Infants and Mothers Effectively (PRIME) cluster randomized trial, which was conducted in Mangochi and Salima districts, in Southern and Central Malawi, respectively
The PRIME cluster randomized trial compared the effectiveness of three service delivery models for retaining HIV-positive women and their HIV-exposed infants in HIV care

Summary

Introduction

In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated to be 74% at 12 months postpartum This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. These include: lack of husband support [10,11,12,13,14]; stigma [10, 12, 14,15,16,17,18]; distance and transport costs [10,11,12, 17, 19]; poor attitude of health workers [3, 17, 20]; food shortage [3, 21]; inadequate counselling [14, 22, 23]; perceived wellness [24,25,26]; side effects of ART [21, 23]; gender inequality; lack of privacy at ART clinics; lack of access to care and treatment; and involuntary HIV disclosure [10,11,12, 21, 22, 27]

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