Retention of HIV exposed infants in care at Arua regional referral hospital, Uganda: a retrospective cohort study

Pontius Apangu,Jonathan Izudi,Francis Bajunirwe,Edgar Mulogo,Vincent Batwala

doi:10.1186/s12889-019-6754-9

Abstract

BackgroundRetention of HIV Exposed Infants (HEIs) in care ensures adequate care. Data on retention of HEIs at large referral hospitals in Uganda is limited. We investigated the retention level of HEIs and associated factors.MethodsWe conducted a retrospective cohort study on 352 HEIs in care (January 2014 and April 2015) at Arua Regional Referral Hospital, North-western Uganda. Electronic medical data were retrieved and analyzed with Stata. Chi-square, Fisher’s exact, and Students t-tests were used for bivariate analysis. Logistic regression was performed to determine factors independently associated with retention.Results236 (67.0%) HEIs were delivered in a health facility and 306 (86.9%) received Nevirapine prophylaxis from birth until 6-weeks. Of mothers, 270 (76.7%) were 25–46 years, 202 (57.4%) attended antenatal care (ANC) at recent pregnancy, and 328 (93.2%) were on life-long anti-retroviral therapy. At 18-months, 277 (78.7%) HEIs were retained in care. Maternal age (25–46 years) (Adjusted Odds Ratio (AOR), 2.32; 95% CI, 1.32–4.06), ANC attendance during recent pregnancy (AOR, 2.01; 95% CI, 1.19–4.3.41) and Nevirapine prophylaxis initiation from birth until 6-weeks (AOR, 3.07; 95% CI, 1.50–6.26) were associated with retention.ConclusionRetention was suboptimal. Older maternal age, ANC visits at last pregnancy, and timely NVP initiation increased retention.

Highlights

Retention of Human Immunodeficiency Virus (HIV) Exposed Infants (HEIs) in care ensures adequate care
Some 306 (86.9%) of the HIV Exposed Infants (HEIs) received Nevirapine prophylaxis from birth up to 6-weeks. 270 (76.7%) of the mothers were in the age group of 25–46 years, 202 (57.4%) attended antenatal care (ANC) visits during recent pregnancy, 328 (93.2%) were on life-long Anti-retroviral Therapy (ART), 264 (75.0%) were in World Health Organization (WHO) clinical stage one at baseline, and 208 (59.1%) had over 500 cells/ml of CD4 count at baseline (Table 1)
This study investigated the level of retention of HEIs along the 18-months of Early Infant Diagnosis of HIV (EID) continuum of care and associated factors at Arua Regional Referral Hospital (ARRH)

Summary

Introduction

Retention of HIV Exposed Infants (HEIs) in care ensures adequate care. Despite the nationwide implementation of Elimination of Mother to Child transmission of Human Immunodeficiency Virus (HIV), abbreviated as EMTCT, and Early Infant Diagnosis of HIV (EID) policies, retention of HIV Exposed Infants (HEIs) in care remains suboptimal [1]. Under EMTCT strategy, HIV positive pregnant and breastfeeding women are enrolled into EID continuum of care at the Mother-baby Care Point, within the Maternal and Child Health (MCH) clinic. HIV positive breastfeeding mothers and HEIs are paired, followed for 18 months. Along the EID continuum of care, data shows that retention of HEIs declines [3,4,5,6,7]. Loss of HEIs is one major factor that accounts for low retention along the Apangu et al BMC Public Health (2019) 19:436

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Conclusion