title: Intra-facility linkage of HIV-positive mothers and HIV-exposed babies into HIV chronic care: rural and urban experience in a resource limited setting.
abstract: BACKGROUND
  Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT) and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID) to inform strategic scale up of PMTCT programs.
  
  
  METHODS
  A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI). HIV-infected pregnant mothers, identified through routine antenatal care (ANC) and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery.
  
  
  RESULTS
  Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26%) in rural and 743/1,025 (74%) in urban facilities. Of these 375/1,025 (37%) were linked to HIV clinics [67/267(25%) rural and 308/758(41%) urban]. Of 636 HIV-exposed babies, 193 (30%) were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636); 8/179 (4.5%)] in rural and 93/457(20.3%) in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1-3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3-15.1), p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings.
  
  
  CONCLUSIONS
  Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to antiretroviral therapy for elimination of MTCT.
authors.affiliation: Infectious Disease Institute, Kampala, Uganda.
authors.forename: Christine
authors.initials: C
authors.lastname: Mugasha
authors.affiliation: Infectious Disease Institute, Kampala, Uganda.
authors.forename: Joanita
authors.initials: J
authors.lastname: Kigozi
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Agnes
authors.initials: A
authors.lastname: Kiragga
authors.affiliation: Infectious Disease Institute, Kampala, Uganda.
authors.forename: Alex
authors.initials: A
authors.lastname: Muganzi
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Nelson
authors.initials: N
authors.lastname: Sewankambo
authors.affiliation: Infectious Disease Institute, Kampala, Uganda.
authors.forename: Alex
authors.initials: A
authors.lastname: Coutinho
authors.affiliation: Infectious Disease Institute, Kampala, Uganda; Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Damalie
authors.initials: D
authors.lastname: Nakanjako
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission*; D006295:Health Resources; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D019035:Rural Health Services; D014454:Uganda; D019037:Urban Health Services