title: Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi.
abstract: OBJECTIVE
  To assess factors, outcomes and reasons for loss to follow-up (LTFU) among pregnant and breastfeeding women initiated on a lifelong antiretroviral therapy (ART) for PMTCT in a large antenatal clinic in Malawi.
  
  
  METHODS
  We identified all pregnant and breastfeeding women who were initiated on ART between September 2011 and September 2013 and had missed their clinic appointment by at least 3 weeks at Bwaila Hospital, the largest antenatal clinic in Malawi. These women were traced by phone or home visits. Their true status and reasons for ART discontinuation were documented during tracing.
  
  
  RESULTS
  A total of 2930 women started ART for PMTCT; 2458 (84%) pregnant and 472 (16%) breastfeeding, of which, 577 (20%) missed a scheduled clinic appointment. LTFU was associated with younger age, being pregnant, and earlier year of ART initiation. We successfully traced 229 (40%), of whom, 10 (4%) had died. Of the 219 women found alive, 118 (54%) had stopped taking ARV drugs, 67 (30%) had self-transferred to another ART clinic, 13 (6%) had collected drugs from other sources, 9 (4%) had treatment interruptions and 12 (5%) had other outcomes. Reasons cited for stopping ART were travel (38%), lack of transport money (16%), not understanding the initial ARV education session (10%), being too weak/sick (10%), ARV side effects (10%) and other reasons.
  
  
  CONCLUSIONS
  Approximately half of the women who were traced were taking ARVs. The study emphasises the need for enhanced post-test counselling strategies, ongoing psychosocial support, provision of incentives and further decentralisation efforts of PMTCT services.
authors.affiliation: The International Union Against Tuberculosis and Lung Disease, Paris, France; Lighthouse Trust, Lilongwe, Malawi; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.forename: Salem
authors.initials: S
authors.lastname: Gugsa
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
authors.forename: Colin
authors.initials: C
authors.lastname: Speight
authors.forename: Wingston
authors.initials: W
authors.lastname: Ng'ambi
authors.forename: Mphatso
authors.initials: M
authors.lastname: Bokosi
authors.forename: Janet
authors.initials: J
authors.lastname: Chikonda
authors.forename: Annie
authors.initials: A
authors.lastname: Chauma
authors.forename: Patricia
authors.initials: P
authors.lastname: Khomani
authors.forename: Malocho
authors.initials: M
authors.lastname: Phoso
authors.forename: Tiwonge
authors.initials: T
authors.lastname: Mtande
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D001942:Breast Feeding; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D059012:Lost to Follow-Up; D008295:Malawi; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000523:psychology / Q000706:statistics & numerical data; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Malawi; Opción B+; Option B+; Prevención de la transmisión madre-hijo; loss to follow-up; perte au suivi; prevention of mother to child transmission; prévention de la transmission mère-enfant; pérdida durante el seguimiento