Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

Abstract Background 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. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods We 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. Results The 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. Conclusion Our 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. Key words PRIME, PMTCT, loss to follow up, mother-infant pairs, retention, Option B+

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Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

10.21203/rs.2.14292/v2 ◽

2019 ◽

Author(s):

Samuel Lawrent Mpinganjira ◽

Timothy Tchereni ◽

Andrews Gunda ◽

Victor Mwapasa

Keyword(s):

Qualitative Study ◽

Health Facilities ◽

System Level ◽

Hiv Care ◽

Hiv Positive ◽

Long Distance ◽

Care Clinic ◽

Loss To Follow Up ◽

Factors Associated

Abstract Background 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 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. Methods We 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 19 LTFU women and conducted in-depth interviews with them and also with 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed and translated and, then, analysed using deductive content analysis. Results The following reasons were reported contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; food insecurity; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system level which contribute to poor retention of mother-infant pairs in HIV care. Key words PRIME, PMTCT, EMTCT, loss to follow up, mother-infant pairs, Option B+

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Factors Associated With Loss-to-follow-up Of Hiv-positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

10.21203/rs.2.14292/v1 ◽

2019 ◽

Author(s):

Samuel Lawrent Mpinganjira ◽

Timothy Tchereni ◽

Andrews Gunda ◽

Victor Mwapasa

Keyword(s):

Qualitative Study ◽

Health Facilities ◽

System Level ◽

Hiv Care ◽

Hiv Positive ◽

Long Distance ◽

Care Clinic ◽

Loss To Follow Up ◽

Factors Associated

Abstract Background In Malawi, loss to follow-up (LTFU) greatly contributes to sub-optimal retention (74%) of HIV-positive (HIV+) women initiated on antiretroviral therapy (ART) during pregnancy under Option B+ strategy. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs (MIP). Methods We 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 MIPs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced 19 LTFU women and conducted in-depth interviews (IDIs) with them and also with 30 healthcare workers (HCWs) from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed and translated and, then, analysed using deductive content analysis. Results The following reasons were reported contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; food insecurity; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system level which contribute to poor retention of MIPs in HIV care. Key words PRIME, PMTCT, eMTCT, loss to follow up, mother-infant pairs, Option B+

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

BMC Public Health ◽

10.1186/s12889-020-8373-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

S. Mpinganjira ◽

T. Tchereni ◽

A. Gunda ◽

V. Mwapasa

Keyword(s):

Qualitative Study ◽

Hiv Care ◽

Hiv Positive ◽

Care Clinic ◽

Loss To Follow Up ◽

Factors Associated ◽

Hiv Positive Mothers

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How Follow-Up Counselling Increases Linkage to Care Among HIV-Positive Persons Identified Through Home-Based HIV Counselling and Testing: A Qualitative Study in Uganda

SAGE Open ◽

10.1177/2158244019900166 ◽

2020 ◽

Vol 10 (1) ◽

pp. 215824401990016

Author(s):

Dominic Bukenya ◽

Janet Seeley ◽

Grace Tumwekwase ◽

Elizabeth Kabunga ◽

Eugene Ruzagira

Keyword(s):

Qualitative Study ◽

Partner Violence ◽

Linkage To Care ◽

Hiv Treatment ◽

Hiv Care ◽

Hiv Positive ◽

Accurate Information ◽

Home Based ◽

Linkage To Hiv Care

We investigated how follow-up counselling had increased linkage to HIV care in a trial of referral to care and follow-up counseling, compared to referral to care only, for participants diagnosed as HIV-positive through home-based HIV counseling and testing. We carried out a cross-sectional qualitative study. Using random stratified sampling, we selected 43 trial participants (26 [60%] in the intervention arm). Sample stratification was by sex, distance to an ART facility, linkage, and nonlinkage to HIV care. Twenty-six in-depth interviews were conducted with participants in the intervention arm: 17 people who had linked to HIV care and 9 who had not linked after 6 months of follow-up. Home-based follow-up counseling helped to overcome worries resulting from an HIV-positive test result. In addition, the counseling offered an opportunity to address questions on HIV treatment side effects, share experiences of intimate partner violence or threats, and general problems linking to care. The counselling encouraged early linkage to HIV care and use of biomedical medicines, discouraging alternative medicine usage. Home-based follow-up counseling also helped to promote HIV sero-status disclosure, facilitating linkage to, retention in and adherence to HIV care and treatment. This study successfully demonstrated that home-based follow-up counselling increased linkage to care through encouragement to seek care, provision of accurate information about HIV care services and supporting the person living with HIV to disclose and manage stigma.

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Daily struggle to take antiretrovirals: a qualitative study in Papuans living with HIV and their healthcare providers

BMJ Open ◽

10.1136/bmjopen-2020-036832 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036832

Author(s):

Elfride Irawati Sianturi ◽

Elmiawati Latifah ◽

Ari Probandari ◽

Christantie Effendy ◽

Katja Taxis

Keyword(s):

Qualitative Study ◽

Healthcare Providers ◽

Hiv Treatment ◽

Hiv Care ◽

Free Access ◽

Personal Factors ◽

Long Distance ◽

Related Factors ◽

Healthcare Environment ◽

Living With Hiv

ObjectiveThe aim of the study was to explore the experiences of Papuans living with HIV to take antiretroviral therapy (ART) from the patient and the healthcare providers (HCPs) perspective.DesignThis was a qualitative study covering all five tribes located in Papua Provinces one of two Indonesian provinces on Papua Island. Semistructured interviews were conducted with Papuans living with HIV and their HCPs. Interviews were transcribed verbatim and coded to find themes.ResultsOverall, we conducted interviews with 13 Papuans living with HIV (mean age: 33 years, 61% female) and 14 HCPs (mean age: 42 years, 64% female) within five customary areas. HCPs included three physicians, nine nurses, two others. Two main themes were identified: (1) personal factors and (2) healthcare environment-related factors. Personal factors were beliefs and knowledge of ART, stigma from family, community and HCPs as well as practical problems such as transportation because of long distance. Within the theme of healthcare environment, the competences and attitudes of HCPs were particularly relevant. The findings are important in refining HIV treatment strategies implemented in Papua, especially when extending HIV care provided by community centres.ConclusionsDespite free access to ART, Papuans living with HIV struggle to remain on treatment. Considering local culture and religion in strategies to reduce stigma should be a priority.

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Retaining HIV-positive patients in HIV care: a personalised approach for those at risk of loss to follow-up at an inner city sexual health service

Sexual Health ◽

10.1071/sh17036 ◽

2018 ◽

Vol 15 (1) ◽

pp. 91

Author(s):

Loretta Healey ◽

Catherine C. O'Connor

Keyword(s):

Health Service ◽

Sexual Health ◽

Text Messages ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Patients ◽

Loss To Follow Up ◽

Sexual Health Service ◽

Lost To Follow Up

In 2013 a personalised approach to follow-up of HIV patients who had withdrawn from HIV care was taken at RPA Sexual Health, a Sydney metropolitan sexual health service. HIV patients were telephoned, sent text messages, emailed and sent letters multiple times where applicable. With this intervention 20 of 23 people who had withdrawn from HIV care re-engaged. Since that time, active follow-up of all people diagnosed with HIV has resulted in only 2% of HIV patients at RPA Sexual Health being lost to follow-up.

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“It is all about the fear of being discriminated [against]…the person suffering from HIV will not be accepted”: a qualitative study exploring the reasons for loss to follow-up among HIV-positive youth in Kisumu, Kenya

BMC Public Health ◽

10.1186/1471-2458-14-1154 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 35

Author(s):

Hilary T Wolf ◽

Bonnie L Halpern-Felsher ◽

Elizabeth A Bukusi ◽

Kawango E Agot ◽

Craig R Cohen ◽

...

Keyword(s):

Qualitative Study ◽

Hiv Positive ◽

Loss To Follow Up

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Factors Associated with Loss to Follow-up among Patients Receiving HIV Treatment in Nairobi, Kenya

AIDS Research and Human Retroviruses ◽

10.1089/aid.2020.0292 ◽

2021 ◽

Author(s):

Emily Koech ◽

Kristen A Stafford ◽

Immaculate Mutysia ◽

Abraham Katana ◽

Marline Jumbe ◽

...

Keyword(s):

Hiv Treatment ◽

Loss To Follow Up ◽

Factors Associated

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Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

Advances in Public Health ◽

10.1155/2018/7540587 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Matilda Kweyamba ◽

Esther Buregyeya ◽

Joy Kusiima ◽

Vianney Kweyamba ◽

Aggrey David Mukose

Keyword(s):

Health Facilities ◽

Hiv Positive ◽

Peer Educators ◽

Mother To Child Transmission ◽

Child Transmission ◽

Loss To Follow Up ◽

Lactating Mothers ◽

Lost To Follow Up ◽

Mother To Child

Background. Mother-to-Child Transmission of HIV accounts for more than 90% of all pediatric HIV infections. However, Prevention of Mother-to-Child Transmission (PMTCT) of HIV through provision of lifelong ART to HIV positive mothers faces various challenges which affect its success. One of such challenges is the loss to follow-up (LTFU) of mothers. Methodology. We conducted a cross-sectional study utilizing both quantitative and qualitative data collection methods. We were able to trace 279 HIV positive, pregnant, and lactating mothers among mothers who were initiated on lifelong ART for PMTCT in public health facilities in Ntungamo district, Western Uganda. The proportion of those who were lost to follow-up was determined, and Log binomial regression with stepwise backward elimination method 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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