Rates and Predictors of HIV-Exposed Infants Lost to Follow-Up During Early Infant Diagnosis Services in Kenya.
DOI: 10.1089/apc.2019.0050; PMCID: PMC6661912
Early infant diagnosis (EID) involves age-specific tracking and testing of HIV-exposed infants during the first 18 months of life and rapid initiation of life-saving treatment for those infected. In Kenya, pre-2013 data estimate EID lost to follow-up (LTFU) at 39-65%, yet no study has documented LTFU rates and predictors throughout the EID cascade since Option B+ fundamentally changed services by placing all HIV-positive expectant mothers on lifelong treatment. Using an explanatory mixed-method design, we assessed LTFU rates and predictors among 870 mother-infant dyads enrolled in EID in six urban/peri-urban Kenyan government hospitals. Mothers completed baseline surveys, and dyads were tracked through EID. We selected 12 baseline variables and modeled odds of LTFU at 9 and 18 months using mixed logistic regression. Qualitative interviews were conducted with 61 mothers to assess barriers and facilitators to completing EID. Thematically coded transcripts were used to interpret quantitative predictors of LTFU. By the 18-month test, 145 dyads (22%) were LTFU, with three-quarters of LTFU occurring between 9- and 18-month tests. Odds of LTFU at 18 months decreased by 10% for each additional year of maternal age and by 66% with HIV status disclosure. Qualitative data revealed how disclosure facilitated essential social support for EID completion and how older mothers attributed maturity and life experience to successful engagement in care. Findings suggest LTFU rates in Kenya have declined, but gaps remain in ensuring universal coverage. Efforts to improve retention should focus on increasing support for younger mothers and those who have not disclosed their HIV status.
AIDS patient care and STDs
Adult; Anti-Retroviral Agents; Early Diagnosis; Female; HIV Infections; Health Services Accessibility; Hospitals, Urban; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Interviews as Topic; Kenya; Lost to Follow-Up; Male; Mothers; Postnatal Care; Pregnancy; Pregnancy Complications, Infectious; Qualitative Research; Social Support; Surveys and Questionnaires; Truth Disclosure
HIV; PMTCT; early infant diagnosis; global health; infants; vertical prevention
Goggin, K., Hurley, E. A., Staggs, V. S., Wexler, C., Nazir, N., Gautney, B., Khamadi, S. A., Maloba, M., Lwembe, R., Finocchario-Kessler, S. Rates and Predictors of HIV-Exposed Infants Lost to Follow-Up During Early Infant Diagnosis Services in Kenya. AIDS patient care and STDs 33, 346-353 (2019).