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Follow up loss of HIV positive pregnant women and lactating mothers in the prevention of mother to child transmission of lifelong antiretroviral therapy in rural Uganda

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Document pages: 10 pages

Abstract: Background HIV mother to child transmission accounts for more than 90 of all children s HIV infection. However, challenges faced by HIV positive mothers to provide life-long antiretroviral therapy to prevent mother to child transmission of HIV are affecting their success. One of the challenges is maternal follow-up loss (LTFU). Methodology we conducted a cross-sectional study using quantitative and qualitative data collection methods. We can track 279 HIV positive, pregnant and lactating mothers in public health facilities in the Ntungamo District of Western Uganda. These mothers are beginning to receive life-long antiretroviral therapy to prevent mother to child transmission. The proportion of patients who lost follow-up was determined and a log binomial regression analysis with stepwise backward elimination was performedod was employed to identify factors associated with LTFU. Focus group discussions (FDGs) of women on lifelong ART and key informant interviews (KIIs) of peer educators were also performed. Results. Out of the 279 mothers that were successfully traced and interviewed, 103 (37 ) were identified as lost to follow-up. The prevalence of LTFU was higher among those whose transport costs were above $2.75, adj (adjusted) PR (Prevalence Ratio) 1.6 (95 CI; 1.02-2.55); those who waited beyond one hour before being attended to, adj PR 1.74 (95 CI; 1.02-2.96); and those who assumed that their infant was already infected, adj PR 1.76 (95 CI; 1.15-2.70). On interviews, LTFU in these mothers was attributed to fear of swallowing antiretroviral drugs, HIV related stigma and discrimination, inadequate facilitation of the peer educators, long patient waiting time, and transportation to the health facilities. Conclusion. More than one-third of mothers initiated on lifelong ART for PMTCT in Ntungamo district were lost to follow-up over a period of 25 months. Recommendations. Provision of regular and adequate pre-ART and ART adherence counseling and provision of routine health education would reduce LTFU.

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