Factors associated with retention of mother-baby pairs in the elimination of mother-to-child transmission of HIV program in Kaberamaido district; a retrospective cohort study.

Abstract

Background: One of the major challenges affecting the eMTCT program globally, regionally, and in Uganda is the high loss to follow-up rates of HIV-positive mother-baby pairs from HIV care and treatment programs. The loss to follow-up rate in Uganda is estimated to range from 30-45%, making the Uganda eMTCT program fall short of the UNAIDS 2030 retention target of 95%. Objective: The objective of this study was to determine the level of at two levels of the eMTCT cascade (at 12 and 18 months) and determine the factors associated with retention of mother-baby pairs at those stages. It is hoped this information will inform the design and implementation of better strategies to improve retention of HIV-positive mother and their HIV-exposed infants in the eMTCT program in Kaberamaido district. Methods: This was a retrospective cohort study. The study involved 368 mother-baby pairs who were enrolled into the eMTCT program in Kaberamaido district from 1st January 2013 to 31st December 2018. of mother-baby pairs in the eMTCT program was assessed at two levels of the eMTCT cascade (at 12 and 18 months) and the factors associated with retention at those levels were determined. Mother-baby pairs were considered to be retained at each of the two levels if they had clinic appointment within the last 30 days or have future appointment date. Data on sociodemographic characteristics, mothers’ ART treatment history, ANC, birth history and postnatal follow up were extracted from EID register and mothers’ ART register and entered into MS Excel and then exported to Stata statistical software package version 14.0 for cleaning, management and analysis. Descriptive statistics such as mean, frequencies and proportions were computed at univariate level. At the bivariate level, logistic regression was performed to assess the level of association between the primary outcome (loss to follow up of mother-baby pair) and each independent variable at two of the six steps of the eMTCT cascade (2nd PCR test and 18 months’ cascade completion). Variables with a P<0.2 at bivariate level were entered into the final multivariable analysis model along with other variables based on biological/clinical plausibility and potential confounders to determine the factors independently associated with retention of mother-baby pairs at 12 and 18 months in the eMTCT program. Results: Of the 368 mothers enrolled into the study, the average age was 29.7years (SD=6.6). Nearly 2/3 of the mothers were married/cohabiting, (n=232, 63.0%), more than half of mother-baby pairs were receiving eMTCT services from health centre IIIs (n=191, 51.9%) and (n=188, 51.1%) of the mothers were enrolled into ART care through OPD. Of the 368 enrolled mother-baby pairs, (n=349, 94.8%) were still active in the eMTCT program at 12 months while 87.8% (n=323) were still active at 18months. The mothers’ viral load suppression was the only factor significantly associated with 12-month retention of mother-baby pairs. Mothers who had suppressed viral load during pregnancy or breastfeeding had higher odds for 12-month retention compared to mothers who had non-suppressed viral load (p=0.027). Mothers who were initiated during the Post-Natal period had lower odds of cascade completion compared to those who initiated ART before pregnancy (p<0.0001). Conclusion: There was high (94.8%?) level of retention of mother-baby pairs in the eMTCT program in Kaberamaido at 12 months, but it was suboptimal at 18months. Maternal viral load suppression(97%retention) and ART initiation during the post-natal period (72.2% retention) were significantly associated with retention of mother-baby pairs at 12 and 18 months respectively.