A.26.Factors contributing to loss to follow up of HIV positive mothers registered on PMTCT Programme
Chikafa V., Bwirire D., Chawawa G., Teck R., Fitzgerald M. (Médecins Sans Frontières Luxembourg, Thyolo)
In early 2002 Médecins Sans Frontières, started a program of prevention of mother to child transmission (PMTCT) of HIV in Thyolo District where an estimated 21% of mothers attending antenatal care services in 2002-3 were HIV seropositive. However despite high uptake at first antenatal visit, over time, most mothers default and only 45% of mothers initially recruited received Nevirapine at 36 weeks gestation. Follow up at age six of infant months was further reduced to 19%. The aim of this study therefore was to understand why there was such a high drop out rate from the PMTCT programme and to see what improvements can be suggested for up scaling.
A total of three focus group discussions (FGD) were conducted with women between September and December 2004. Three facilitators were trained - two social communicators and one nurse. Criteria for inclusion in the FGD were, being an antenatal mother (10 women), being a postnatal mother registered under PMTCT (6 women) and also being a nurse or midwife serving in PMTCT (9 nurses). Sessions were held in Thyolo district hospital and in the community. An average of six women attended each group discussion with an age range of 20 to 55 years.
Reasons cited by participants for dropping out of the PMTCT programme included stigma and discrimination in the community, lack of support from husband and friends, better service from traditional birth attendants, unacceptable artificial feeding options, delay in provision of Nevirapine by hospital staff, prolonged patient waiting at the hospital on day of clinic and lack of financial resources (transport for hospital visit and money for formula feeding).
Conclusion and Recommendation
This study highlights the important cultural and social issues that should be considered in scaling up the PMTCT programme.