Loss to Follow Up and Associated Factors among Women Enrolled in PMTCT Program in Mbeya Region, Tanzania, 2017

  • Public health surveillance
  • Viral hepatitis and HIV
  • Maternal and child health
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Background:
More than half of people living with HIV in Sub-Saharan Africa are women. Approximately 1.4 million become pregnant each year; effective implementation of Prevention of Mother to Child Transmission (PMTCT) services, can reduce rate of these women infecting their children to as low as 2%. Loss to follow up (LTFU) stands a major problem to effective PMTCT services in Tanzania. Therefore, we looked at factors associated with LTFU among women enrolled in PMTCT program at health facilities in Mbeya region, Tanzania.
Methods:
We conducted retrospective cohort study with a nested case control analysis for associated factors. Women enrolled in PMTCT between 1st October, 2016 and 31st
March, 2017 in selected health facilities were eligible for the study. A woman was LTFU if consistently out of ART > 90 days since last scheduled appointment within follow up period (1st
October, 2016 to 30th June, 2017). These were considered as cases in nested case control analysis. Controls were those started ART under PMTCT, never missed their last scheduled clinic appointment > 90 days within follow up period. We extracted information from 627 patients’ files using data extraction tool to identify cases and controls. Interviewer administered questionnaire with information on socio-demographic and factors associated with LTFU was used to interview 123 cases and 246 controls. Data were entered, cleaned and analyzed using Epi Info 3.5.4 data analysis software.
Results:
The rate of LTFU was 3.613 per 100 person-months of follow up (95% CI: 3.0-4.3). Among women who were LTFU, half [52.8% (42.8-61.1)] were lost between 1 to 3 months with median follow up time (IQR) of 3(1-5) months. LTFU was associated with age less than 25 years [AOR 2.4 (1.3-4.2)] and not having a treatment supporter at home [AOR 1.98(1.24-3.17)]. Women who lived 1km to 3kms, and more than 3 kms away from clinic had lower odds of loss to follow up [AOR 0.49 (0.28-0.84)] and [AOR 0.17 (0.09-0.32)] respectively.
Conclusion
LTFU occurs early after enrollment and more substantial for young women. Presence of treatment supporter and distance to the facility plays an important role in retention to care.

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