20th International AIDS Conference - Melbourne, Australia


THAX0101 - Oral Abstract Session

Loss to follow-up among women in PMTCT Option B+ programme in Lilongwe, Malawi: understanding outcomes and reasons

Presented by Hannock Tweya (Malawi).

H. Tweya1,2, S. Gugsa1, M. Hosseinipour3, C. Speight1, W. Ng'ambi1, M. Bokosi1, J. Chikonda4, A. Chauma4, V. Sampathkumar5, T. Mtande3, P. Khomani6, S. Phiri1

1Lighthouse Trust, Lilongwe, Malawi, 2The International Union Against Tuberculosis and Lung Disease, Paris, France, 3University of North Carolina Project, Lilongwe, Malawi, 4Ministry of Health, District Health Office, Lilongwe, Malawi, 5Mothers2Mothers, Lilongwe, Malawi, 6Baobab Health Trust, Lilongwe, Malawi

Background: Use of antiretroviral therapy in women infected with HIV significantly reduces vertical transmission. However, loss to follow-up (LTFU) from care is a considerable barrier to the effectiveness of prevention of mother to child transmission (PMTCT). To date, approximately 28% of women starting PMTCT through Option B+ are lost from care at 12 months post ART initiation in Malawi. Using routine tracing programme data, we sought to describe the outcome and reasons for LTFU of patients.
Methods: We conducted a retrospective cohort study based on routine data from a patient tracing programme at Bwaila Hospital, the largest antenatal clinic in Malawi. Pregnant and breastfeeding women who are infected with HIV are started on lifelong ART regardless of their immunological or clinical status (PMTCT Option B+). We identified pregnant and breastfeeding women who were initiated on ART, consented to be contacted during registration, and have missed their clinic appointment by at least three weeks. These women were traced by phone or home visits. Their true status and reasons for ART discontinuation were documented during tracing.
Results: Between July 2011 and September 2013, 3030 women started ART for PMTCT; 2552 (84%) pregnant and 478 (16%) breastfeeding, of which, 596 (20%) missed a scheduled clinic appointment. We successfully traced 241 (40%) and established that 10 (4%) had died. Of the 231 women found alive, 124 (54%) had stopped taking drugs, 70 (30%) self-transferred to another ART clinic, 15 (6%) had collected drugs from other sources, 10 (4%) had treatment interruptions, 7 (3%) had not started taking drugs despite collecting them and 5 (2%) refused to be interviewed. Frequently cited reasons for stopping ART were travel (36%), lack of transport to the clinic (15%), not understanding the initial ARV education session (10%), being too weak/sick (9%) and 16% other reasons. Seventeen percent of women who stopped ART returned after tracing.
Conclusions: Most women who are LTFU from PMTCT programme had stopped ART or self-transferred to another clinic. Active follow-up of women who miss clinic appointment resulted in retaining some women in care. Adequate counselling strategies could improve ART retention in PMTCT option B+ strategy.

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