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Vulnerable at Each Step in the PMTCT Care Cascade: High Loss to Follow Up During Pregnancy and the Postpartum Period in Tanzania

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Abstract

In 2013, Tanzania adopted the World Health Organization’s Option B+ guidelines for prevention of mother-to-child transmission of HIV (PMTCT), whereby all HIV-infected pregnant women initiate lifelong antiretroviral therapy. This study examined retention in PMTCT across critical junctures in the care continuum. This was a retrospective study of patient-level data for a cohort of women enrolled in PMTCT during the first year of Option B+ in Tanzania. Retention in care was described across three periods: (1) the first month of antenatal care (ANC), (2) pregnancy, and (3) the postpartum period. Logistic regression was used to identify factors associated with loss to follow up (LTFU) during the first month of ANC. Survival analyses were used to identify factors associated with LTFU during pregnancy and the postpartum periods. 650 participants were included in the cohort; 262 (40.3%) were newly diagnosed with HIV. Two years after delivery, 383/650 (58.7%) were LTFU. Of the 383 LTFU, 73 (19.1%) were lost during the first month of ANC, 44 (11.5%) during pregnancy, and 266 (69.5%) after delivery. Being newly diagnosed with HIV predicted higher LTFU during the first month of ANC (aOR 1.76; 95% CI 1.06–2.94) and faster time to LTFU during the postpartum period (adjusted relative time, 0.68; 95% CI 0.51–0.89). High LTFU occurred across the PMTCT continuum, including immediately after enrollment into ANC and the postpartum period. Ongoing research is needed to encourage treatment uptake and sustained engagement after delivery.

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Acknowledgements

This study was supported by a grant from the NIH National Institute of Allergies and Infectious Diseases (NIAID): Postpartum HIV care engagement in the context of Option B+ in Tanzania (R21 AI124344, MPI Watt/Mmbaga). Additionally, this work was supported in part by the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at Duke University; Cody Cichowitz is a Doris Duke International Clinical Research Fellow. Finally, we acknowledge support received from the Duke Center for AIDS Research (P30 AI064518). None of the funders had any involvement in the study or the preparation of this manuscript.

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Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Cody Cichowitz, Brandon A. Knettel & Melissa H. Watt

  2. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Cody Cichowitz

  3. Kilimanjaro Christian Medical University College, Moshi, Tanzania

    Festo Mazuguni, Prosper Njau & James Ngocho

  4. Kilimanjaro Clinical Research Institute, Box 2236, Moshi, Tanzania

    Cody Cichowitz, Linda Minja, James Ngocho & Blandina T. Mmbaga

  5. Prevention of Mother-to-Child Transmission HIV and National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania

    Prosper Njau

  6. Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania

    Gretchen Antelman

  7. Kilimanjaro Christian Medical Centre, Moshi, Tanzania

    Blandina T. Mmbaga

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  1. Cody Cichowitz
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  2. Festo Mazuguni
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  9. Blandina T. Mmbaga
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Correspondence to Blandina T. Mmbaga.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Cichowitz, C., Mazuguni, F., Minja, L. et al. Vulnerable at Each Step in the PMTCT Care Cascade: High Loss to Follow Up During Pregnancy and the Postpartum Period in Tanzania. AIDS Behav 23, 1824–1832 (2019). https://doi.org/10.1007/s10461-018-2298-8

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  • DOI: https://doi.org/10.1007/s10461-018-2298-8

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