Retention in HIV care and associated factors among young breastfeeding mothers on lifelong antiretroviral therapy in Soroti District, a mixed methods study
Authors: Akello Faith , Muteebwa Laban , Ononge Sam , Bakeera Sabrina K. 
Published: February 2024

Abstract

Introduction: Young women aged 15-24 years living with Human Immunodeficiency Virus (HIV) are less likely to receive the full package of prevention of mother-to-child transmission (PMTCT) interventions compared to older women. While option B-plus policy has led to a reduction in mother-to-child transmission (MTCT) of HIV infections, a sizable proportion of exposed infants (14%) still get HIV infection from their mothers. We aimed to determine the level of retention in HIV care, its barriers, facilitators and associated factors among breastfeeding young mothers on lifelong ART in Soroti district, Uganda.
Methods: We used an explanatory sequential mixed-methods study design to recruit young women from three study sites including Soroti Regional Referral Hospital, TASO-Soroti and Uganda Cares-Soroti, all in Soroti district. In the quantitative study, we selected a cohort of 249 breastfeeding young mothers aged 15-24 years that attended the ART clinics at study health facilities between 1st January 2017 and 31st December 2021 using a systematic random sampling of the health records. The main outcome was retention in HIV care measured at each of the Elimination of mother to child transmission of HIV visits in the post-partum phase as recommended by the Ministry of Health. Retention in care was measured as a binary outcome at 6 weeks, 10 weeks, 14 weeks, 5 months, 6 months, 9 months, 12 months, 15 months and 18 months after child birth. The factors associated with retention in HIV care were assessed using a multi-level mixed effects logistic regression in STATA version 14.0. 18 breastfeeding young mothers who were enrolled in PMCTC care between 1st January 2020 and 31st December 2021 were invited by phone call to participate in in-depth interviews to explore barriers and facilitators to retention in HIV care. Interviews were conducted between 19th August and 15th September 2022 at the respective study sites. Inductive thematic analysis approach was used to analyze qualitative data.
Results; The median age of mothers was 22 years. Majority were married (79.9%), had a treatment supporter and had disclosed their HIV status (88.3%). Retention in care was highest at 6 weeks (83.5%; 95%CI: 78.4-87.7) lowest at 15 months (23.3%; 95%CI: 18.4-29.0) and was (72.7%; 95%CI: 66.8-77.9) at 18 months. Having timely infant PCR done at 6 weeks was associated with retention, OR=0.27(95%CI; 0.15-0.50). The motivators to retention in care were mothers’ attitude towards ART, having disclosed HIV status, support from the health facility, desire to stay alive, friendly health workers and the need to be able to care for their children. The major barrier to retention was transport costs.
Conclusion; Retention among young mothers is below the Ministry of Health (MOH) target of 90%. Interventions specifically targeted at enhancing financial independence among the young mothers are required so as to try and improve retention in care in an effort to meet MOH targets and eventually eradicate HIV in Uganda.