Factors Influencing Retention In Prevention Of Mother-To- Child Transmission Services During The Post-Natal Period Among Women Living With HIV In The Shai-Osudoku District Hospital

Abstract

Background: Globally, the burden of HIV/AIDS on maternal and child health calls for a global collaborative response to the Prevention of Mother- to- Child Transmission of HIV. Prevention of Mother- To -Child Transmission (PMTCT) program coverage has been scaled up globally to eliminate new pediatric HIV infections by 2020. Despite the scale-up in plans, there is growing evidence of high new pediatric infections in Sub-Saharan Africa countries including Ghana. Aim: The purpose of this study was to estimate the retention rate in PMTCT services and explore the factors influencing retention in PMTCT services during the post-natal period among women living with HIV in the Shai- Osudoku District Hospital. Methods: The study employed both quantitative and qualitative designs to reflect research objectives. A sample of 51 women enrolled into the PMTCT programme from January 2019 to December 2020 and in 12- 18 months postpartum secondary data was extracted from the ART database. Data was imported into STATA version 16 software and analyzed using descriptive statistics and results were presented in frequency distribution and tables. The retention rate was determined using univariate analysis in the form of descriptive statistics. Thirteen (13) respondents were then recruited for in-depth interviews using an interview guide. Data was translated and transcribed. Transcribed data was imported into ATLAS.ti9 and analyzed for emerging themes. Results: In this study, the sample had a mean age of 34 years with a standard deviation of 4.75. Thirty-six (70.5%) of them had basic level of education, 11(21.6%) had secondary level education, 1 (2.0%) had tertiary level of education and 3(5.9%) of them had no formal education. Approximately, 25 (49.0%) were involved in informal work such as farming, hairdressing, tailoring, trading, whilst 21 (41%) were involved in formal works such as teaching, nursing. Out of the 51participants 44 (86.3%) of them were Christians and were either married or cohabiting and 7 (13.7%) were Muslims. All (100%) of the sample completed all the schedules for ANC PMTCT. 90.2% of the sample reported for first Postnatal PMTCT visit, 58.2% reported for second Postnatal PMTCT visit and 49% reported for third Post-natal PMTCT visit. Thirty-eight (38) out of the fifty-one participants reported at the facility for infant PCR test at 6 weeks after zidovudine/Nevirapine prophylaxis had been given. For retention rate analysis, 29 (56.9%) were of active status, 17 (33.3%) had defaulted/lost to follow up following birth, 3 (5.9%) had been transferred to other facilities for continuity of care and 2 (3.9%) died during the programme period. Maternal factors likely to influence PMTCT retention includes; PMTCT literacy. Service provider factors identified to influence retention include; supportive working environment, supportive counselling role of health professionals, privacy and confidentiality. Socio-cultural factors identified to influence PMTCT service include; male partner support, HIV status disclosure, family and peer support and stigma. Conclusion: The level of retention in PMTCT during the post-natal phase in the Shai-Osudoku District Hospital was lower compared to other low -resource settings reviewed in literature. Good knowledge and understanding of PMTCT programme, supportive working environment, supportive counselling role, assurance of privacy and confidentiality, partner, family and peer support/acceptance are some of the factors that influence retention rate in PMTCT at the study site. It therefore critical for service providers to tailor activities of the programme with a high sense of empathy and a system of tracking women in the programme to achieve higher retention rate in the programme.