Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014

Details

• Alternative Title:
  BMC Infect Dis
• Personal Author:
  Ngandu, Nobubelo Kwanele ; Jackson, Debra ; Lombard, Carl ; Nsibande, Duduzile Faith ; Dinh, Thu-Ha ; Magasana, Vuyolwethu ; Mogashoa, Mary ; Goga, Ameena Ebrahim
• Description:
  Background
  
  Since 2001 the South African guidelines to improve child health and prevent vertical HIV transmission recommended frequent infant follow-up with HIV testing at 18 months postpartum. We sought to understand non-attendance at scheduled follow-up study visits up to 18 months, and for the 18-month infant HIV test amongst a nationally representative sample of HIV exposed uninfected (HEU) infants from a high HIV-prevalence African setting.
  
  Methods
  
  Secondary analysis of data drawn from a nationally representative observational cohort study (conducted during October 2012 to September 2014) of HEU infants and their primary caregivers was undertaken. Participants were eligible (N = 2650) if they were 4–8 weeks old and HEU at enrolment. All enrolled infants were followed up every 3 months up to 18 months. Each follow-up visit was scheduled to coincide with each child’s routine health visit, where possible. The denominator at each time point comprised HEU infants who were alive and HIV-free at the previous visit. We assessed baseline maternal and early HIV care characteristics associated with the frequency of ‘Missed visits’ (MV-frequency), using a negative binomial regression model adjusting for the follow-up time in the study, and associated with missed visits at 18 months (18-month MV) using a logistic regression model.
  
  Results
  
  The proportion of eligible infants with MV was lowest at 3 months (32.7%) and 18 months (31.0%) and highest at 12 months (37.6%). HIV-positive mothers not on triple antiretroviral therapy (ART) by 6-weeks postpartum had a significantly increased occurrence rate of ‘MV-frequency’ (adjusted incidence rate ratio, 1.2 (95% confidence interval (CI), 1.1–1.4), p < 0.0001). Compared to those mothers with ART, these mothers also increased the risk of ‘18-month-MV’ (adjusted odds ratio, 1.3 (CI, 1.1–1.6), p = 0.006). Unknown infant nevirapine-intake status increased the rate of ‘MV-frequency’ (p = 0.02). Mothers > 24 years had a significantly reduced rate of ‘MV-frequency’ (p ≤ 0.01) and risk of ‘18-month-MV’ (p < 0.01) compared to younger women. Shorter travel time to health facility lowered the occurrence of ‘MV-frequency’ (p ≤ 0.004).
  
  Conclusion
  
  Late initiation of maternal ART and infant prophylaxis under the Option- A policy and extended travel time to clinics (measured at 6 weeks postpartum), contributed to higher postnatal MV rates. Mothers older than 24 years had lower MV rates. Targeted interventions may be needed during the current PMTCT Option B+ (lifelong ART to pregnant and lactating women at HIV diagnosis) to circumvent these risk factors and reduce missed visits during HIV-care.
  
  Electronic supplementary material
  
  The online version of this article (10.1186/s12879-019-4340-5) contains supplementary material, which is available to authorized users.
  
  
• Subjects:
  HIV-exposed Infants Missed Visits Postnatal Care Research
• Source:
  BMC Infect Dis. 19(Suppl 1)
• Pubmed ID:
  31526372
• Pubmed Central ID:
  PMC6745773
• Document Type:
  Journal Article
• Volume:
  19
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:09d2f7ef9ff4a78fce22a2c8d71b297e8a26aff9c9a218ffd0a36b3b2683e6930eff552e075237c6cde6d0f8bcfe089a0a9e7048adb055935bd4a4c00e2e0c39
• Download URL:
  https://stacks.cdc.gov/view/cdc/82520/cdc_82520_DS1.pdf
• File Type:
  [PDF - 461.62 KB ]