Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study

Abstract Background Loss to follow-up (LTFU) deprives HIV-exposed infants the lifesaving care required and results in exposing HIV free infants to virus requisition risk. We aimed to determine the rate of LTFU, postnatal mother-to-child HIV-transmission and to identify maternal factors associated with LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral Hospital PMTCT clinic. Methods Study participants were infants born to HIV-positive mothers enrolled in the PMTCT clinic for HIV care at Mbarara Regional Referral Hospital. While access database in the Early Infant Diagnosis (EID) clinic provided data on infants, the open medical record system database at the ISS clinic provided that for mothers. Infants were classified as LTFU if they had not complete their follow-up schedule by 18 months of age. At 18 months, an infant is expected to receive a rapid diagnostic test before being discharged from the PMTCT clinic. Postnatal MTCT of HIV was calculated as a proportion of infants followed and tested from birth to 18 months of age. Logistic regression was used to determine possible associations between mothers’ characteristics and LTFU. In-depth interviews of mothers of LTFU infants and health workers who attend to the HIV-exposed infants were carried out to identify factors not captured in the electronic database. Results Out of 1624 infants enrolled at the clinic, 533 (33%) were dropped for lack of mother’s clinic identification number, 18 (1.1%) were either dead or transferred out. Out of 1073 infants analysed, 515 (48%) were LTFU while out of the 558 who completed their follow-up schedule, 20 (3.6%) tested positive for HIV. Young age of mother, far distance to hospital and non-use of family planning were identified as outstanding factors responsible for LTFU. In addition, in-depth interviews revealed facility-level factors such as “waiting time”. Conclusion This study has revealed a high rate of LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral hospital PMTCT clinic. Young maternal age, long distance to health facility and failure to use family planning were significantly associated with LTFU. Incorporating family planning services in the ART and PMTCT clinics could reduce LTFU of these infants.

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Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: A retrospective study

10.21203/rs.3.rs-16526/v2 ◽

2020 ◽

Author(s):

Rogers Ankunda ◽

Samuel Nambile Cumber ◽

Catherine Atuhaire ◽

Kabanda Taseera ◽

Claude Ngwayu Nkfusai ◽

...

Keyword(s):

Family Planning ◽

Referral Hospital ◽

Hiv Care ◽

Maternal Factors ◽

Regional Referral Hospital ◽

Loss To Follow Up ◽

Hiv Exposed Infants ◽

Hiv Exposed ◽

Depth Interviews

Abstract Background Loss to follow-up (LTFU) deprives HIV-exposed infants the lifesaving care required and results in exposing HIV free infants to virus requisition risk. We aimed to determine the rate of LTFU, postnatal mother-to-child HIV-transmission and to identify maternal factors associated with LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral Hospital PMTCT clinic. Methods Study participants were infants born to HIV-positive mothers enrolled in the PMTCT clinic for HIV care at Mbarara Regional Referral Hospital. While access database in the Early Infant Diagnosis (EID) clinic provided data on infants, the open medical record system database at the ISS clinic provided that for mothers. Infants were classified as LTFU if they had not complete their follow-up schedule by 18 months of age. At 18 months, an infant is expected to receive a rapid diagnostic test before being discharged from the PMTCT clinic. Postnatal MTCT of HIV was calculated as a proportion of infants followed and tested from birth to 18 months of age. Logistic regression was used to determine possible associations between mothers’ characteristics and LTFU. In-depth interviews of mothers of LTFU infants and health workers who attend to the HIV-exposed infants were carried out to identify factors not captured in the electronic database. Results Out of 1624 infants enrolled at the clinic, 533 (33%) were dropped for lack of mother’s clinic identification number, 18 (1.1%) were either dead or transferred out. Out of 1073 infants analysed, 515 (48%) were LTFU while out of the 558 who completed their follow-up schedule, 20 (3.6%) tested positive for HIV. Young age of mother, far distance to hospital and non-use of family planning were identified as outstanding factors responsible for LTFU. In addition, in-depth interviews revealed facility-level factors such as “waiting time”. Conclusion This study has revealed a high rate of LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral hospital PMTCT clinic. Young maternal age, long distance to health facility and failure to use family planning were significantly associated with LTFU. Incorporating family planning services in the ART and PMTCT clinics could reduce LTFU of these infants.

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

BMC Public Health ◽

10.1186/s12889-019-6754-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Pontius Apangu ◽

Jonathan Izudi ◽

Francis Bajunirwe ◽

Edgar Mulogo ◽

Vincent Batwala

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Referral Hospital ◽

Regional Referral Hospital ◽

Hiv Exposed Infants ◽

Hiv Exposed

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Reducing loss to follow-up of HIV exposed infants in Central Mozambique

Annals of Global Health ◽

10.1016/j.aogh.2016.04.609 ◽

2016 ◽

Vol 82 (3) ◽

pp. 377 ◽

Cited By ~ 2

Author(s):

M. Napúa ◽

J.L. Manuel ◽

L. Costa Vieira ◽

S. Beste ◽

C. Michel ◽

...

Keyword(s):

Loss To Follow Up ◽

Hiv Exposed Infants ◽

Hiv Exposed

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Loss to follow-up of HIV-exposed infants in South London

International Journal of STD & AIDS ◽

10.1258/095646203321264999 ◽

2003 ◽

Vol 14 (4) ◽

pp. 291-292 ◽

Cited By ~ 3

Author(s):

I-C Sam ◽

C S Ball ◽

M J Blott ◽

J H C Tosswill ◽

J V Parry ◽

...

Keyword(s):

Loss To Follow Up ◽

Hiv Exposed Infants ◽

Hiv Exposed

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Diabetes Case Burden at Central Regional Referral Hospital, Gelephu, Bhutan; A Retrospective Study

International Healthcare Research Journal ◽

10.26440/ihrj/0402.05345 ◽

2020 ◽

Vol 4 (2) ◽

pp. 38-43

Author(s):

Vishal Chhetri ◽

Hari Prasad Pokhrel ◽

Lungten Zangmo ◽

Laigden Dzed

Keyword(s):

Type 2 Diabetes ◽

Fold Increase ◽

Referral Hospital ◽

Diabetic Patients ◽

Ageing Population ◽

Regional Referral Hospital ◽

Loss To Follow Up ◽

Case Load

BACKGROUND: Diabetes is a metabolic disorder affecting millions of people globally. The incidence of type 2 diabetes is increasing rapidly in Bhutan. Anecdotal evidences show poor compliance and loss to follow up among the Bhutanese population living with diabetes. This study was conducted to understand the case load, age and gender distribution and compliance to follow up among diabetic patients registered at Central Regional Referral Hospital, Gelephu, Bhutan. MATERIALS & METHOD: All the patients diagnosed and registered with Diabetic Clinic between 1st January 2014 to 31st December 2018 were included in the study.RESULTS: There was a sharp increase in number of registered diabetic patients from 641 cases in 2014 to 1590 cases in 2018. A total of 949 new cases were diagnosed and registered during the study period of which 52% were women. The overall diabetes prevalence under Gelephu CRRH catchment area is found to be 2.91% with lowest at Chhudzom (1.01%) and highest in Samtenling Gewog (3.18%). Lost to follow up among new cases for past four years was found to be 3.96%, 5.0%, 6.47% and 5.85% from 2015 to 2018 respectively.CONCLUSION: The ageing population and sedentary lifestyle has contributed to the sharp escalation of type 2 diabetes cases in Gelephu. The hospital recorded total of 1590 cases in 2018 which is a two-fold increase in case load within a span of five years. The current analysis found that loss to follow up was 3.96%, 5.0%, 6.47% and 5.85% from 2015 to 2018 respectively among new cases of diabetes registered with the hospital.

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Correlates of loss to follow-up and missed diagnosis among HIV-exposed infants throughout the breastfeeding period in southern Mozambique

PLoS ONE ◽

10.1371/journal.pone.0237993 ◽

2020 ◽

Vol 15 (8) ◽

pp. e0237993

Author(s):

Maria Grazia Lain ◽

Sergio Chicumbe ◽

Ana Rosa de Araujo ◽

Esmeralda Karajeanes ◽

Aleny Couto ◽

...

Keyword(s):

Loss To Follow Up ◽

Hiv Exposed Infants ◽

Missed Diagnosis ◽

Hiv Exposed

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Outcomes of HIV Exposed Infants and Predictors of Positivity after Option B+ Guideline Implementation in Amhara Regional State’s Referral Hospitals, Ethiopia

10.21203/rs.2.17124/v1 ◽

2019 ◽

Cited By ~ 1

Author(s):

Mesfin Wudu Kassaw ◽

Ayele Mamo Abebe ◽

Kenean Getaneh Tilaye ◽

Gedefaw Diress ◽

Mikiyas Amare Getu ◽

...

Keyword(s):

Incidence Rate ◽

Hiv Transmission ◽

Hiv Positive ◽

Pmtct Program ◽

Loss To Follow Up ◽

Hiv Exposed Infants ◽

Regional State ◽

Referral Hospitals ◽

Hiv Exposed

Abstract Background: Elimination of MTCT of HIV was a global public health priority. In 2013, the World Health Organization recommended antiretroviral therapy administration to all HIV positive pregnant, and breastfeeding women regardless of CD4 cell count or clinical stage, which is called “Option B+”. Ethiopia have had a high rate of MTCT of HIV. The rate of transmission on breastfeeding mothers was 24% in 2012. But the rate had been increased to more than 30% in 2015.Objective: This study aimed to determine outcomes of HIV exposed infants, explore the contributors of mortality and loss to follow up, and identify factors of HIV transmission among infants born from HIV positive mothers in Amhara regional state referral hospitals, Ethiopia, 2018/19. Methods: The study was done in five Amhara regional state referral hospitals’ PMTCT departments. A simple random sampling technique with proportional allocation was used to assess the outcomes of 217 exposed infants. A retrospective quantitative cohort design and qualitative exploratory design were used in all referral hospitals of the Amhara region. The data were collected from each hospital exposed infant medical record, which was documented between January 01/2014 and May 30/2017 . An in-depth interview was also taken place from health professionals working in the PMTCT department, zonal HIV officers, and mothers who are enrolled in the PMTCT department. A cumulative incidence rate was used to present mortality, transmission, and loss to follow- up.Results: The incidence rate of HIV transmission at enrollment to PMTCT program in Amhara regional state referral hospitals was 2.3% (95% CI, 0.5-4.6%), and 3.7 (95% CI, 1.4-6.5) at the time of completing PMTCT program using antibody or DNA-PCR test. Whereas the incidence rate of LTFU in Amhara regional state referral hospitals was 8.8% (95% CI, 5.4-12.4%). But the rate of mortality after enrollment to the program was zero. The interviewees’ opinions on mortality, and loss to follow up were categorized into themes.Conclusions: Irrespective of the WHO guideline expected outcome of option B+, the outcome of the PMTCT program in this study was high, particularly HIV transmission and LTFU.

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