Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi

OBJECTIVE: To assess factors outcomes and reasons for loss to follow-up (LTFU) among pregnant and breastfeeding women initiated on a lifelong antiretroviral therapy (ART) for PMTCT in a large antenatal clinic in Malawi. METHODS: We identified all pregnant and breastfeeding women who were initiated on ART between September 2011 and September 2013 and had missed their clinic appointment by at least 3 weeks at Bwaila Hospital the largest antenatal clinic in Malawi. These women were traced by phone or home visits. Their true status and reasons for ART discontinuation were documented during tracing. RESULTS: A total of 2930 women started ART for PMTCT; 2458 (84%) pregnant and 472 (16%) breastfeeding of which 577 (20%) missed a scheduled clinic appointment. LTFU was associated with younger age being pregnant and earlier year of ART initiation. We successfully traced 229 (40%) of whom 10 (4%) had died. Of the 219 women found alive 118 (54%) had stopped taking ARV drugs 67 (30%) had self-transferred to another ART clinic 13 (6%) had collected drugs from other sources 9 (4%) had treatment interruptions and 12 (5%) had other outcomes. Reasons cited for stopping ART were travel (38%) lack of transport money (16%) not understanding the initial ARV education session (10%) being too weak/sick (10%) ARV side effects (10%) and other reasons. CONCLUSION: Approximately half of the women who were traced were taking ARVs. The study emphasises the need for enhanced post-test counselling strategies ongoing psychosocial support provision of incentives and further decentralisation efforts of PMTCT services. (c) 2014 John Wiley & Sons Ltd.