Title : Missed opportunities for preventing mother to child HIV transmission in the dolutegravir era; A matched case control study from a tertiary hospital in Uganda
Abstract:
Introduction: Missed opportunities in the prevention of mother to child transmission of HIV (PMTCT) cascade account for the highest proportion of vertical transmissions observed in the era of dolutegravir. However, these and the factors associated with them have not been well described. We analyzed missed opportunities and associated factors at a high-volume tertiary hospital in Uganda.
Methods: This was a matched case control study.Cases were perinatally exposed HIV Infected children while Controls were HIV Exposed Uninfected children under 5years of age admitted at MNRH. We determined the prevalence of missed opportunities, and conditional logistic regression was used to obtain the odds of missed opportunities among cases compared to the controls. Modified poison regression was used to analyze the factors associated with missed opportunities. We also documented and ranked the frequencies of mother-reported reasons for missing opportunities.
Results: The mean age of study participants was 24.4 (+16.6) months. The prevalence of any missed opportunity was 33/45(73.3%) among cases and 18/135(13.3%) among controls. Missed opportunities in maternal HIV testing [OR 11.0, CI = 3.07, 39.42] and Nevirapine use [OR 5.84, CI=1.11, 30.61] were associated with Mother to child HIV transmission. Factors associated with missed opportunities included maternal stigma PR
1.63 CI [1.05, 2.52] and late diagnosis of HIV PR 3.35 CI [1.96, 5.73]. Mother-reported reasons for missed opportunities included services not provided by the health facilities.
Conclusion: The prevalence of any missed opportunity was high. Maternal experience of stigma was associated with substantially higher missed opportunity along the PMTCT cascade
Keywords: Missed opportunity, PMTCT Cascade, HIV, children, Mulago, Uganda
