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ISRN AIDS  2012 

Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa

DOI: 10.5402/2012/589817

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Purpose. The purpose of this paper was to explore how loss to followup (LFTU) has affected the successful implementation of prevention of mother to child transmission of HIV-1 (PMTCT) programs in sub-Saharan Africa. Methods. We conducted an electronic search from the following databases PubMed, ScienceDirect, Directory of Open Access Journals (DOAJs), and PyscINFO. Additional searches were made in WHO, UNAIDS, UNICEF, Google, and Google scholar websites for (1) peer-reviewed published research, (2) scientific and technical reports, and (3) papers presented on scientific conferences. Results. A total of 678 articles, published from 1990 to 2011, were retrieved. Only 44 articles met our inclusion criteria and were included in the study. The rates of LTFU of mother-child pairs ranged from 19% to 89.4 in the reviewed articles. Health facility factors, fear of HIV-1 test, stigma and discrimination, home deliveries and socioeconomic factors were identified as reasons for LTFU. Conclusion. There is a great loss of mother-child pairs to follow up in PMTCT programs in sub-Saharan Africa. There is need for more research studies to develop public health models of care that can help to improve followup of mother-child pairs in PMTCT programs in Sub-Saharan Africa. 1. Introduction In sub-Saharan Africa an estimated 60% of people living with HIV-1 are women mostly in reproductive age group. Each year approximately 1.4 million HIV-1 positive women become pregnant. Among antenatal clients in sub-Saharan Africa the proportion of women living with HIV-1 ranges from 5% to as high as 30%, and vertical transmission is the main cause of infection among children [1]. Transmission of HIV-1 from mother to child can take place during pregnancy, labor, and delivery as well as after birth via breastfeeding especially in mixed feeding. The risk of transmission varies at different stages with the risk during pregnancy ranging from 5–10%, 10–20% during labor and delivery, and 10–20% through mixed infant feeding. It is estimated that in the absence of any intervention to prevent mother-to-child transmission (MTCT) ranges from 15–45%. This rate can be reduced to levels below 5% with effective interventions [2]. Prevention of mother-to-child transmission of HIV-1 program consists of a range of interventions, including improved antenatal services, opt-out HIV-1 counseling and testing for pregnant women, antiretroviral drug prophylaxis for HIV-1 positive pregnant women and newborns, referral to support groups, and counseling on options for safer infant feeding practices. A comprehensive


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