Loss to follow up after pregnancy among mothers enrolled on the option Bþ program in Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Public Health in Practice
Abstract
Option-Bþ programs in Uganda have reported high levels of loss to follow up (LTFU) after cessation of
breastfeeding, and this remains unknown beyond this period. In this study, we assessed the incidence and factors
associated with LTFU two to four years after delivery among Option-Bþ mothers.
Study design: Retrospective cohort.
Methods: We reviewed files of 452 mothers who enrolled on Option-Bþ between January 1st, 2013 and December
31st, 2014 at Kisenyi Health Centre IV in Kampala district. We assessed factors associated with LTFU using Cox
proportional hazards regression. We also explored the reasons for LTFU using three focus group discussions, five
in-depth and three key informant interviews.
Results: Of the 452 mothers, 131(29%) were LTFU after delivery. The incidence of LTFU after delivery was 17/
1000 person months (95% CI, 14–30/1000) with a median follow up of 32 months. The risk of LTFU was higher
among mothers who started ART on the day they tested HIV positive (aHR ¼ 1.66, 95% CI; 1.25–2.20, p-value<
0.001). Reasons for LFTU included transport costs, stigma, poor human resource policies and non-disclosure.
Conclusion: LTFU after delivery among Option-Bþ mothers is higher than the global target of 15%. ART initiation
on the day a mother tests positive increases the risk of LTFU. The major reasons for LTFU were stigma and nondisclosure.
To reduce the risk of LTFU, we recommend approaches that encourage disclosure to sexual partners
and ongoing specific support to mothers who are initiated on ART-the day of positive test.
Description
Keywords
Loss to follow up, Option-Bþ mothers, After delivery
Citation
Kiirya, Y., Musoke, P., Obeng-Amoako, G. A. O., & Kalyango, J. (2021). Loss to follow up after pregnancy among mothers enrolled on the option B+ program in Uganda. Public Health in Practice, 2, 100085. https://doi.org/10.1016/j.puhip.2021.100085