Incidence and predictors of lost to follow-up among women under option B+ PMTCT program at Debre Berhan town, Amhara, Ethiopia 2024: a retrospective follow-up study

Abstract

Background Option B + is an advanced strategy in the Prevention of Mother-to-Child Transmission (PMTCT) recommended by the World Health Organization to enhance the care for HIV-positive pregnant and lactating women. Lost to follow-up in the Prevention of Mother-to-Child Transmission service poses a significant public health challenge. Yet, there is limited understanding of the incidence and predictors influencing LTFU among HIV-infected women under the Option B + PMTCT program. Methods A retrospective follow-up study was conducted at various health institutions in Debre Birehan town from March 11 to April 11, 2024. Simple random sampling was used to select 280 HIV-infected Pregnant and lactating women under option B + PMTCT service. Data were extracted from the PMTCT registers and individual medical records using a checklist, and linked together for analysis. The patients' characteristics were analyzed in terms of frequency and percentage. The cumulative survival probability of loss to follow-up was determined using the Kaplan-Meier survivor estimator and predictors influencing LTFU were identified using the Cox regression model. All potential predictors with a p-value of < 0.05 at a 95% confidence interval were declared statistically significant and presented as Adjusted Hazard Ratios. Result The cumulative incidence rate of loss to follow-up (LTFU) was found to be 8.04 (95% CI 5.6–11.3) cases per 1000 person-months with restricted mean survival time of 25.14 (95% CI: 24.25–26.04) months. The median follow-up time of the follow-up period was 16 (IQR 10–19) months. Lower level of formal education (AHR 9.8, 95% CI 1.2–21), non-disclosure of HIV status (AHR 3.0, 95% CI 1.6–12.4), and fair antiretroviral drug adherence (AHR 3.0, 95% CI 1.6–12.4) were significantly associated with lost to follow-up among women. Conclusions and recommendations: The overall incidence rate of lost to follow-up is higher than the national and World Health Organization target. Lost to follow-up was found to be influenced by educational status, disclosure of HIV status, and level of medication adherence.