Review Article

Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa

Table 1

Summary of studies on rates of LTFU in PMTCT program in sub-Saharan Africa.

First authorDesignStudy population CountryMethodResults

Manzi, 2005 [20]Cohort study646 HIV-positive pregnant womenMalawiReview of routine antenatal, VCT and PMTCT registersThe cumulative LTFU was 358 (55%, CI: 51–59) by the 36-week antenatal visit, 440 (68%, CI: 64–71) by delivery, 450 (70%, CI: 66–73) by the first postnatal visit, and 524 (81%, CI: 78–84) by the 6-month postnatal visit
Mirkuzie, 2010 [31]Descriptive retrospective study135,986 HIV-positive women. EthiopiaReview of PMTCT monthly reports10.6% (896) (95% CI 9.9–11.2) of the HIV-positive women completed their followup to child HIV testing
Stringer, 2005 [28] Surveillance study 8787 mother-infant pairsZambia Mother-infant pairs surveillance675 of 2257 (30%) seropositive mother-infant pairs received both maternal and infant dose of NVP
Sherman, 2004 [5]Descriptive retrospective study 1234 HIV-positive mothers and their exposed infantsSouth AfricaAssessment of the efficacy (PMTCT) program70% LTFU by 4 months postnatally
Perez, 2004 [11]Cross-sectional study2298 pregnant womenZimbabweMonitoring of PMTCT Program uptake 104 (24%) mother-child pairs received nevirapine prophylaxis
Kasenga, 2007 [21]Descriptive retrospective study75 HIV-positive womenMalawiFollowup of HIV-positive women registered in PMTCT program 35 (47%) LTFU by delivery
Nyandiko, 2010 [33]Retrospective cohort study2477 HIV-exposed infants KenyaComparing MTCT and infant survival rates329 (27.4%) LTFU by 18 months of age
Kurewa, 2007 [26]Nested case control594 HIV-negative and 456 HIV positive mothersZimbabweComparison between HIV-negative and HIV-positive mothers.At 9 months the overall dropout rate was 19%
Chetty, 2011 [24]Retrospective cohort268 HIV-exposed infantsSouth AfricaPostnatal followup of data abstracted from patients records105/260 (40.4%) infants lost to followup
Mirkuzie, 2011 [32]Retrospective cohort study282 HIV-positive mothersEthiopiaFollowup of mother-infant pairs115 (48%) mother-infant pairs LTFU by 6 weeks postnatally
Doherty, 2005 [25]Cross-sectional study.14340 HIV-positive women and their HIV-exposed childrenSouth AfricaMonthly data collection on PMTCT outcomes50% mother-child pairs LTFU by 12 months postnatally
Msellati, 2001 [29]Routine PMTCT data collection and analysis445 positive pregnant womenIvory CoastRoutine collection of PMTCT data177/445 (40%) of HIV-positive women lost to followup by the end of 6 months
van Lettow, 2011 [22]Matched cohort study173 HIV-infected and 214 HIV-uninfected mother-child pairsMalawiFollowup of mother-infant pairs28% of exposed infants were followed and tested at least once by 18–20 months of age, and only 18% of mothers followed all current PMTCT recommendations
Rosen, 2011 [18]Cross-sectional study113 HIV-positive pregnant womenEthiopiaInterview and focus group discussion71 (95.9%) of HIV-infected women were lost to followup by delivery
Kurewa, 2011 [27]Cohort study479 HIV-exposed infantsZimbabweFollowup of HIV-exposed infants 247 (51.6%) exposed infants turned up in the first year
Moth, 2005 [34]A cross-sectional exploratory study133 clients registered for PMTCT servicesKenyaReview of logbooks, exit interviews, indepth interviews, nonparticipant observations, and testimonies on experiencesLTFU was 11% before pretest counseling, 23.5% during HIV test, 31.5% during collection of HIV result, 53.6% during enrollment, and 80.7% at delivery
Mute, 2011 [30]Cross-sectional surveyof 230 HIV-positive pregnantMaliQuestionnaire and semistructure interviewsLTFU was 53% (122) of HIV-positive women
Moses, 2008 [23]Retrospective study20,000 HIV-positive pregnant womenMalawifollowup of mother and infant pair35% of the infected mothers returned with their babies at 6-week postnatal followup.