Factors associated with retention of mother baby pairs in the elimination of mother-to child transmission of HIV program in Kaberamaido district: A longitudinal analysis

Abstract

Retention along the elimination of Mother to Child Transmission (eMTCT) cascade in Ugandaremains poor asonly 62.7%-69.5% are followed up to 18months. The objective of this study was to determine the rates of retention of mother-baby pairs at two levels of the eMTCTcascade(12and18months)andassociated factors. Methods This was alongitudinal analysis of 368 mother-baby pairs who were enrolled into the eMTCTprograminKaberamaido district from January 2013 to December 2018. Data was extracted from early infant diagnosis (EID) and mothers’ ART registers, entered into Micro soft Excel and then exported to Stata statistical software package version 14.0 for manage ment andanalysis. Descriptive statistics such as mean and frequencies were computed at univariate level. At the bivariate level, Cox proportional hazard regression was performed to assess the level of association between the primary outcome and each independent vari able, while Cox proportional hazard regression model was built at multivariate level to deter mine the factors independently associated with retention of mother-baby pairs in the eMTCTprogram. Results Of the 368mothers enrolled into the study, their average age was 29.7years (SD = 6.6). Nearly two-thirds of the mothers were married/cohabiting, (n = 232, 63.0%). The 368 mother baby pairs were observed for a total time of 6340 person months, with majority, 349 (94.8%, 95%CI=92.0–96.7) still active in eMTCT care, while 19(5.2%, 95%CI = 3.3–8.0) were lost to follow up at 12months. At 18 months, 323 (87.8%, 95%CI = 84.0–90.8) were active in eMTCTprogramwhile45(12.2%, 95CI=9.2–16.0) were lost to follow up. At bivariate level, marital status, health facility level of enrolment, mothers’ ART treatment supporter, and mothers’ ART enrolment time were significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs along the eMTCT cascade. At multivariable level, the mothers’ time of ARTinitiation was significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs at along the eMTCT cascade, with mothers-baby pairs who were initiated during the antenatal/post-natal periods having higher hazards of LTFU compared to those whoinitiated ART before Antenatal period (before pregnancy), aHR = 4.37(95%CI, 1.62 11.76, P = 0.003). Mother-baby pairs who were enrolled into the eMTCT program after the implementation of HIV test and treat policy (year 2017 and 2018) had higher hazards of LTFUascomparedtothoseenrolled before the implementation of test and treat policy in Uganda(year 2013–2016), aHR =2.22(95% CI, 1.15–4.30, P =0.017). All the other factors hadnosignificant association with lost to follow up and cascade completion at multivariate level. Conclusion There washigh level of retention of mother-baby pairs in the eMTCT program in Kabera maido at 12months, but it was suboptimal at 18months. ART initiation during the antenatal and/or post-natal period was significantly associated with suboptimal retention of mother baby pairs along the eMTCT cascade.