Predictors of loss to follow-up among children registered in an HIV prevention mother-to-child transmission cohort study in Pernambuco, Brazil.

Pedro Alves Da Cruz Gouveia,Maria ,Gerlane Alves Pontes Da Silva

doi:10.1186/1471-2458-14-1232

Abstract

BackgroundMother-to-child transmission of HIV (MTCT) is the major form of acquiring the disease among children. The loss to follow-up (LTF) of mothers and their children is a problem that affects the effectiveness of programs for the prevention of mother-to-child transmission (PMTCT). The aim of this study is to identify risk factors associated with the LTF of HIV-exposed children in the state of Pernambuco, Brazil.MethodsA retrospective cohort study was carried out with 1200 HIV-exposed children born between 2000 and 2009, registered up to the age of 2 months in a public health PMTCT program. Children were considered LTF if they did not return for scheduled visits to monitor infection status. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for LTF.ResultsA total of 185 children (15.4%; CI: 95%: 13.4 - 17.4%) met the case definition of LTF before the determination of serological HIV status. Risk factors independently associated with LTF were mother-child pairs who reside in rural and remote areas (OR 1.86; 95% CI: 1.30-2.66) and mothers who use illicit drugs (OR 1.8; 95% CI: 1.08-3.0). Initiation of the PMTCT during pregnancy was a protective factor for LTF (OR 0.69; 95% CI: 0.49-0.96).ConclusionsThe decentralization of support services for HIV-exposed children to other cities in the state seems to be crucial for the accurate monitoring of outcomes. It is also important to introduce additional measures addressing mothers who are drug users so that they remain in the program: an intensive follow-up program that actively searches for absentee mother-child pairs, support from social services and treatment for drug-dependency. The findings of this study highlight the importance of diagnosing mothers as early as possible in order to conduct a more complete follow-up period of the children. Solving the above-mentioned problems is a challenge, which must be overcome so as to improve the quality of PMTCT.

Highlights

Mother-to-child transmission of HIV (MTCT) is the major form of acquiring the disease among children
During the study period seven children died, but were not excluded or considered loss to follow-up (LTF) because they died in the presence of class B or C diagnosis according to CDC pediatric case definition of HIV-1/AIDS
One protective factor encountered for LTF was the initiation of prevention of mother-to-child transmission (PMTCT) during pregnancy, when compared to initiating PMTCT at delivery or with the newborn and to missed PMTCT opportunities

Summary

Introduction

Mother-to-child transmission of HIV (MTCT) is the major form of acquiring the disease among children. The loss to follow-up (LTF) of mothers and their children is a problem that affects the effectiveness of programs for the prevention of mother-to-child transmission (PMTCT). The aim of this study is to identify risk factors associated with the LTF of HIV-exposed children in the state of Pernambuco, Brazil. One of the challenges when analyzing the potential effectiveness of interventions brought about by programs for the prevention of mother-to-child transmission (PMTCT) is the loss to follow-up (LTF) of mothers and their children. Such high LTF rates experienced by PMTCT programs preclude them from identifying and managing HIVinfected children [5] This is a reflection of the failings in PMTCT and is one of the reasons that more than 90% of the children who acquired HIV infection in 2011 live in sub-Saharan Africa [6].

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