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
References
[1]
UNAIDS, “Report on the global AIDS Epidemic,” 2010, http://www.unaids.org/globalreport/global_report.htm.
[2]
WHO, “Prevention of Mother-to-child transmission of HIV-1,” 2011, http://www.who.int/HIV-1/topics/mtct/en/nm.
[3]
T. M. Painter, K. L. Diaby, D. M. Matia et al., “Sociodemographic factors associated with participation by HIV-1-positive pregnant women in an intervention to prevent mother-to-child transmission of HIV in C？te d'Ivoire,” International Journal of STD and AIDS, vol. 16, no. 3, pp. 237–242, 2005.
[4]
S. A. Jones, G. G. Sherman, and C. A. Varga, “Exploring socio-economic conditions and poor follow-up rates of HIV-exposed infants in Johannesburg, South Africa,” AIDS Care, vol. 17, no. 4, pp. 466–470, 2005.
[5]
G. G. Sherman, S. A. Jones, A. H. Coovadia, M. F. Urban, and K. D. Bolton, “PMTCT from research to reality—results from a routine service,” South African Medical Journal, vol. 94, no. 4, pp. 289–292, 2004.
[6]
UNICEF, Briefing Paper, “Scaling up early infant diagnosis and linkages to care and treatment,” 2009, http://www.unicef.org/aids/files/EIDWorkingPaperJune02.pdf.
[7]
K. Patel, M. A. Hernán, P. L. Williams et al., “Long-term effects of highly active antiretroviral therapy on CD4+ cell evolution among children and adolescents infected with HIV: 5 years and counting,” Clinical Infectious Diseases, vol. 46, no. 11, pp. 1751–1760, 2008.
[8]
E. Arrive, B. Marquis, N. Tumwesigye, et al., “Response to Anti-Retroviral Therapy (ART) in children in Sub-Saharan Africa: a pooled analysis of clinical databases—the KIDS-ART-LINC collaboration,” in Proceedings of the 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, Calif, USA, February 2007.
[9]
L. A. Guay, P. Musoke, T. Fleming et al., “Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial,” The Lancet, vol. 354, no. 9181, pp. 795–802, 1999.
[10]
M. Badri, R. Ehrlich, R. Wood, and G. Maartens, “Initiating co-trimoxazole prophylaxis in HIV-infected patients in Africa: an evaluation of the provisional WHO/UNAIDS recommendations,” AIDS, vol. 15, no. 9, pp. 1143–1148, 2001.
[11]
F. Perez, T. Mukotekwa, A. Miller et al., “Implementing a rural programme of prevention of mother-to-child transmission of HIV in Zimbabwe: first 18 months of experience,” Tropical Medicine and International Health, vol. 9, no. 7, pp. 774–783, 2004.
[12]
UNAIDS, “World leaders launch plan to eliminate new HIV-1 infections among children by 2015,” 2011, http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2011/june/20110609prglobalplanchildren/.
[13]
B. Merdekios and A. Adedimeji, “Effectiveness of interventions to prevent mother-to-child transmission of HIV-1 in Southern Ethiopia,” International Journal of Women’s Health, vol. 3, pp. 359–366, 2011.
[14]
T. Horvath, B. C. Madi, I. M. Iuppa, G. E. Kennedy, G. Rutherford, and J. S. Read, “Interventions for preventing late postnatal mother-to-child transmission of HIV,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD006734, 2009.
[15]
AVERT, “Preventing mother to child transmission PMTCT in practice,” 2011, http://www.avert.org/pmtct-hiv.htm.
[16]
H. S. F. Fraser, C. Allen, C. Bailey, G. Douglas, S. Shin, and J. Blaya, “Information systems for patient follow-up and chronic management of HIV and tuberculosis: a life-saving technology in resource-poor areas,” Journal of Medical Internet Research, vol. 9, no. 4, article e29, 2007.
[17]
R. Reithinger, K. Megazzini, S. J. Durako, D. R. Harris, and S. H. Vermund, “Monitoring and evaluation of programmes to prevent mother to child transmission of HIV in Africa,” British Medical Journal, vol. 334, no. 7604, pp. 1143–1146, 2007.
[18]
S. Rosen and M. P. Fox, “Retention in HIV care between testing and treatment in Sub-Saharan Africa: a systematic review,” PLoS Medicine, vol. 8, no. 7, Article ID e1001056, 2011.
[19]
S. Rosen, M. P. Fox, and C. J. Gill, “Patient retention in antiretroviral therapy programs in Sub-Saharan Africa: a systematic review,” PLoS Medicine, vol. 4, no. 10, pp. 1691–1701, 2007.
[20]
M. Manzi, R. Zachariah, R. Teck et al., “High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting,” Tropical Medicine and International Health, vol. 10, no. 12, pp. 1242–1250, 2005.
[21]
F. Kasenga, A. K. Hurtig, and M. Emmelin, “Home deliveries: implications for adherence to nevirapine in a PMTCT programme in rural Malawi,” AIDS Care, vol. 19, no. 5, pp. 646–652, 2007.
[22]
M. van Lettow, R. Bedell, M. Landes et al., “Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT) program in Zomba district, Malawi,” BMC Public Health, vol. 11, article 426, 2011.
[23]
A. Moses, C. Zimba, E. Kamanga et al., “Prevention of mother-to-child transmission: program changes and the effect on uptake of the HIVNET 012 regimen in Malawi,” AIDS, vol. 22, no. 1, pp. 83–87, 2008.
[24]
T. Chetty, L. Butler, J. Giddy, T. Crankshaw, S. Knight, and M. L. Newell, “HIV-1—transmission, mortality and loss to follow-up of HIV-1—exposed infants enrolled in a programme providing integrated PMTCT and child health services in an urban hospital in KwaZulu?Natal,” University of Kwazulu Natal, Durban, South Africa, 2011, http://www.africacentre.ac.za/Portals/0/News%20Archive/SA%20AIDS%20Conf%202011/13%20TerushaChetty.pdf.
[25]
T. M. Doherty, D. McCoy, and S. Donohue, “Health system constraints to optimal coverage of the prevention of mother-to-child HIV transmission programme in South Africa: lessons from the implementation of the national pilot programme,” African Health Sciences, vol. 5, no. 3, pp. 213–218, 2005.
[26]
N. E. Kurewa, M. M. Munjoma, Z. M. Chirenje, S. Rusakaniko, A. Hussain, and B. Stray-Pedersen, “Compliance and loss to follow up of HIV negative and positive mothers recruited from a PMTCT programme in Zimbabwe,” The Central African Journal of Medicine, vol. 53, no. 5–8, pp. 25–30, 2007.
[27]
E. N. Kurewa, G. Q. Kandawasvika, F. M. Mhlanga, et al., “Realities and challenges of a five year follow up of mother and child Pairs on a PMTCT program in Zimbabwe,” The Open AIDS Journal, vol. 5, pp. 51–58, 2011.
[28]
J. S. A. Stringer, M. Sinkala, C. C. Maclean et al., “Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia,” AIDS, vol. 19, no. 12, pp. 1309–1315, 2005.
[29]
P. Msellati, G. Hingst, F. Kaba, I. Vino, C. Welffens-Ekra, and F. Dabis, “Operational issues in preventing mother-to-child transmission of HIV-1 in Abidjan, C？te d'Ivoire, 1998-99,” Bulletin of the World Health Organization, vol. 79, no. 7, pp. 641–647, 2001.
[30]
T. Mute, A. Akondé, A. Doumbia, et al., “The prevention of mother-to-child transmission of HIV-1 in Mali HIV-1-positive pregnant women and loss to follow-up in the Segou region,” 2011, https://docs.google.com/viewer?a=v&q=cache:d0ibePa11x0J:www.solthis.org/fr/espace-infos/documents/mali/107-110726162013201107iasromeposterpdvptmemutel/download.html+The+prevention+of+mother-to-child+transmission+of+HIV-1+in+Mali+HIV-1-positive+pregnant+women+and+loss+to+follow-up+in+the+Segou+region&hl=en&gl=hk&pid=bl&srcid=ADGEESj5aIgnUq-kZlnFI5uYvRyfb3xMgJid9m25eUsZ-2Lw26RxcBww16LiCEa-zu3Y1jRz_7M-LX6B7UGp3FJbBmVJ0puJAy5X-MJShUMAj6F9-IdSd4Mbg-PElpQLn5DnFQCvINZ2&sig=AHIEtbRLftSIAcrxQ0Wg4Bn4TGSbTYp4tQ.
[31]
A. H. Mirkuzie, S. G. Hinderaker, and O. M？rkve, “Promising outcomes of a national programme for the prevention of mother-to-child HIV transmission in Addis Ababa: a retrospective study,” BMC Health Services Research, vol. 10, article 267, 2010.
[32]
A. H. Mirkuzie, S. G. Hinderaker, M. M. Sisay, K. M. Moland, and O. M？rkve, “Current status of medication adherence and infant follow up in the prevention of mother to child HIV-1 transmission programme in Addis Ababa: a cohort study,” Journal of the International AIDS Society, vol. 14, article 50, 2011.
[33]
W. M. Nyandiko, B. Otieno-Nyunya, B. Musick et al., “Outcomes of HIV-exposed children in Western Kenya: efficacy of prevention of mother to child transmission in a resource-constrained setting,” Journal of Acquired Immune Deficiency Syndromes, vol. 54, no. 1, pp. 42–50, 2010.
[34]
I. A. Moth, A. B. Ayayo, and D. O. Kaseje, “Assessment of utilisation of PMTCT services at Nyanza Provincial Hospital, Kenya,” Journal of Social Aspects of HIV/AIDS, vol. 2, no. 2, pp. 244–250, 2005.
[35]
H. Nuwagaba-Biribonwoha, R. T. Mayon-White, P. Okong, and L. M. Carpenter, “Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda,” Journal of Public Health, vol. 29, no. 3, pp. 269–274, 2007.
[36]
J. A. Raburu, “Factors influencing quality of maternal health services: a case study of Nyanza and Nakuru Provincial Hospitals,” Kenya Nursing Journal, vol. 32, no. 2, pp. 23–29, 2004.
[37]
A. Coutsoudis, K. Pillay, E. Spooner, L. Kuhn, and H. M. Coovadia, “Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study,” The Lancet, vol. 354, no. 9177, pp. 471–476, 1999.
[38]
L. D. Bwirire, M. Fitzgerald, R. Zachariah et al., “Reasons for loss to follow-up among mothers registered in a prevention-of-mother-to-child transmission program in rural Malawi,” Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 102, no. 12, pp. 1195–1200, 2008.
[39]
T. M. Painter, K. L. Diaby, D. M. Matia et al., “Women's reasons for not participating in follow up visits before starting short course antiretroviral prophylaxis for prevention of mother to child transmission of HIV: qualitative interview study,” British Medical Journal, vol. 329, no. 7465, pp. 543–546, 2004.
[40]
V. Bond, E. Chase, and P. Aggleton, “Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia,” Evaluation and Program Planning, vol. 25, no. 4, pp. 347–356, 2002.
[41]
A. Medley, C. Garcia-Moreno, S. McGill, and S. Maman, “Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes,” Bulletin of the World Health Organization, vol. 82, no. 4, pp. 299–307, 2004.
[42]
Y. Lim, J. Y. Kim, M. Rich et al., “Improving prevention of mother-to-child transmission of HIV care and related services in Eastern Rwanda,” PLoS Medicine, vol. 7, no. 7, Article ID e1000302, 2010.
[43]
A. Mahomva, S. Greby, S. Dube et al., “HIV prevalence and trends from data in Zimbabwe, 1997–2004,” Sexually Transmitted Infections, vol. 82, no. 1, pp. i42–i47, 2006.
[44]
C. Baek and N. Rutenberg, “Looking backward, moving forward: implementing PMTCT programs in resource-constrained settings, Horizons studies. 1999–2007,” Horizons Synthesis Background Papers, Population Council, Washington, DC, USA, 2010.
[45]
E. J. Abrams, L. Myer, A. Rosenfield, and W. M. El-Sadr, “Prevention of mother-to-child transmission services as a gateway to family-based human immunodeficiency virus care and treatment in resource-limited settings: rationale and international experiences,” American Journal of Obstetrics & Gynecology, vol. 197, no. 3, pp. S101–S106, 2007.
[46]
F. Rouet, D. K. Ekouevi, M. L. Chaix et al., “Transfer and evaluation of an automated, low-cost real-time reverse transcription-PCR test for diagnosis and monitoring of human immunodeficiency virus type 1 infection in a West African resource-limited setting,” Journal of Clinical Microbiology, vol. 43, no. 6, pp. 2709–2717, 2005.
[47]
B. Tonwe-Gold, D. K. Ekouevi, C. Amani-Bose et al., “Implementing family-focused HIV care and treatment: the first 2 years' experience of the mother-to-child transmission-plus program in Abidjan, C？te d'Ivoire,” Tropical Medicine and International Health, vol. 14, no. 2, pp. 204–212, 2009.
[48]
A. Calmy, E. Klement, R. Teck et al., “Simplifying and adapting antiretroviral treatment in resource-poor settings: a necessary step to scaling-up,” AIDS, vol. 18, no. 18, pp. 2353–2360, 2004.
[49]
J. S. A. Stringer, I. Zulu, J. Levy et al., “Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes,” Journal of the American Medical Association, vol. 296, no. 7, pp. 782–793, 2006.
[50]
Bridges.org, Testing the Use of SMS Reminders in the Treatment of Tuberculosis in Cape Town, South Africa, City of Cape Town Health Directorate and the International Development Research Council (IDRC), Cape Town, South Africa, 2005.
[51]
T. Tsertsvadze, T. Kakabadze, K. Shermadini et al., “Prevention of mother-to-child transmission of HIV: the Georgian experience,” Central European Journal of Public Health, vol. 16, no. 3, pp. 128–133, 2008.
[52]
M. Cocu, C. Thorne, R. Mǎtu？a et al., “Mother-to-child transmission of HIV infection in Romania: results from an education and prevention programme,” AIDS Care, vol. 17, no. 1, pp. 76–84, 2005.
[53]
T. G. Heckman, A. M. Somlai, J. Peters et al., “Barriers to care among persons living with HIV/AIDS in urban and rural areas,” AIDS Care, vol. 10, no. 3, pp. 365–375, 1998.
[54]
P. A. Cook, J. Downing, C. P. Wheater et al., “Influence of socio-demographic factors on distances travelled to access HIV services: enhanced surveillance of HIV patients in north west England,” BMC Public Health, vol. 9, article 78, 2009.
[55]
T. Creek, A. Tanuri, M. Smith et al., “Early diagnosis of human immunodeficiency virus in infants using polymerase chain reaction on dried blood spots in Botswana's national program for prevention of mother-to-child transmission,” Pediatric Infectious Disease Journal, vol. 27, no. 1, pp. 22–26, 2008.
[56]
C. McDonald, J. Lambert, D. Nayagam et al., “Why are children still being infected with HIV? Experiences in the prevention of mother-to-child transmission of HIV in south London,” Sexually Transmitted Infections, vol. 83, no. 1, pp. 59–63, 2007.
[57]
L. M. Mofenson, “Advances in the prevention of vertical transmission of human immunodeficiency virus,” Seminars in Pediatric Infectious Diseases, vol. 14, no. 4, pp. 295–308, 2003.
[58]
S. Kanshana and R. J. Simonds, “National program for preventing mother-child HIV transmission in Thailand: successful implementation and lessons learned,” AIDS, vol. 16, no. 7, pp. 953–959, 2002.
[59]
K. Gamazina, I. Mogilevkina, Z. Parkhomenko, A. Bishop, P. S. Coffey, and T. Brazg, “Improving quality of prevention of mother-to-child HIV transmission services in Ukraine: a focus on provider communication skills and linkages to community-based non-governmental organizations,” Central European Journal of Public Health, vol. 17, no. 1, pp. 20–24, 2009.
[60]
J. D. Hamadani, S. N. Huda, F. Khatun, and S. M. Grantham-McGregor, “Psychosocial stimulation improves the development of undernourished children in Rural Bangladesh,” Journal of Nutrition, vol. 136, no. 10, pp. 2645–2652, 2006.
[61]
J. S. Mukherjee, L. Ivers, F. Leandre, P. Farmer, and H. Behforouz, “Antiretroviral therapy in resource-poor settings: decreasing barriers to access and promoting adherence,” Journal of Acquired Immune Deficiency Syndromes, vol. 43, no. 1, pp. S123–S126, 2006.
[62]
S. Albrecht, K. Semrau, P. Kasonde et al., “Predictors of nonadherence to single-dose nevirapine therapy for the prevention of mother-to-child HIV transmission,” Journal of Acquired Immune Deficiency Syndromes, vol. 41, no. 1, pp. 114–118, 2006.
[63]
A. Anita, T. Delvaux, B. Elul, et al., Evaluation of Access to and Utilization of Services for the Prevention of Mother-to-Child Transmission (PMTCT) of HIV-1 in Rwanda Summary Report, Ministry of Health, Kigali, Rwanda, 2007.
[64]
M. Panditrao, S. Darak, V. Kulkarni, S. Kulkarni, and R. Parchure, “Socio-demographic factors associated with loss to follow-up of HIV-infected women attending a private sector PMTCT program in Maharashtra, India,” AIDS Care, vol. 23, no. 5, pp. 593–600, 2011.
[65]
N. T. Hanh, T. M. Gammeltoft, and V. Rasch, “Number and timing of antenatal HIV testing: evidence from a community-based study in Northern Vietnam,” BMC Public Health, vol. 11, article 183, 2011.
[66]
A. OKeeffe, J. Godwin, and R. Moodie, “HIV/AIDS in the Asia Pacific Region: analytical report for the white paper on Australia’s aid program Thailand,” 2005, http://www.hivpolicy.org/Library/HPP000676.pdf.
[67]
N. Rutenberg, M. L. Field-Ngwuer, and L. Nyblade, “Community Involvement in the prevention of mother-to-child Transmission of HIV-1: insights and recommendations,” 2012, http://www.popcouncil.org/pdfs/mtct.pdf.
[68]
R. Byamugisha, J. K. Tumwine, N. Semiyaga, and T. Tyllesk？r, “Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-sectional survey,” Reproductive Health, vol. 7, no. 1, article 12, 2010.
[69]
J. Njunga and A. Blystad, “The divorce program: gendered experiences of HIV positive mothers enrolled in PMTCT programs—the case of rural Malawi,” International Breastfeeding Journal, vol. 5, article 14, 2010.
