Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014
| dc.contributor.author | Ngandu, Nobubelo K | |
| dc.contributor.author | Jackson, Debra | |
| dc.contributor.author | Lombard, Carl | |
| dc.contributor.author | Nsibande, Duduzile F | |
| dc.contributor.author | Dinh, Thu-Ha | |
| dc.contributor.author | Magasana, Vuyolwethu | |
| dc.contributor.author | Mogashoa, Mary | |
| dc.contributor.author | Goga, Ameena E | |
| dc.date.accessioned | 2019-10-10T09:02:05Z | |
| dc.date.available | 2019-10-10T09:02:05Z | |
| dc.date.issued | 2019-09-16 | |
| dc.date.updated | 2019-09-22T03:32:50Z | |
| dc.description.abstract | Abstract Background Since 2001 the South African guidelines to improve child health and prevent vertical HIV transmission recommended frequent infant follow-up with HIV testing at 18 months postpartum. We sought to understand non-attendance at scheduled follow-up study visits up to 18 months, and for the 18-month infant HIV test amongst a nationally representative sample of HIV exposed uninfected (HEU) infants from a high HIV-prevalence African setting. Methods Secondary analysis of data drawn from a nationally representative observational cohort study (conducted during October 2012 to September 2014) of HEU infants and their primary caregivers was undertaken. Participants were eligible (N = 2650) if they were 4–8 weeks old and HEU at enrolment. All enrolled infants were followed up every 3 months up to 18 months. Each follow-up visit was scheduled to coincide with each child’s routine health visit, where possible. The denominator at each time point comprised HEU infants who were alive and HIV-free at the previous visit. We assessed baseline maternal and early HIV care characteristics associated with the frequency of ‘Missed visits’ (MV-frequency), using a negative binomial regression model adjusting for the follow-up time in the study, and associated with missed visits at 18 months (18-month MV) using a logistic regression model. Results The proportion of eligible infants with MV was lowest at 3 months (32.7%) and 18 months (31.0%) and highest at 12 months (37.6%). HIV-positive mothers not on triple antiretroviral therapy (ART) by 6-weeks postpartum had a significantly increased occurrence rate of ‘MV-frequency’ (adjusted incidence rate ratio, 1.2 (95% confidence interval (CI), 1.1–1.4), p < 0.0001). Compared to those mothers with ART, these mothers also increased the risk of ‘18-month-MV’ (adjusted odds ratio, 1.3 (CI, 1.1–1.6), p = 0.006). Unknown infant nevirapine-intake status increased the rate of ‘MV-frequency’ (p = 0.02). Mothers > 24 years had a significantly reduced rate of ‘MV-frequency’ (p ≤ 0.01) and risk of ‘18-month-MV’ (p < 0.01) compared to younger women. Shorter travel time to health facility lowered the occurrence of ‘MV-frequency’ (p ≤ 0.004). Conclusion Late initiation of maternal ART and infant prophylaxis under the Option- A policy and extended travel time to clinics (measured at 6 weeks postpartum), contributed to higher postnatal MV rates. Mothers older than 24 years had lower MV rates. Targeted interventions may be needed during the current PMTCT Option B+ (lifelong ART to pregnant and lactating women at HIV diagnosis) to circumvent these risk factors and reduce missed visits during HIV-care. | |
| dc.identifier.apacitation | Ngandu, N. K., Jackson, D., Lombard, C., Nsibande, D. F., Dinh, T., Magasana, V., ... Goga, A. E. (2019). Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014. http://hdl.handle.net/11427/30565 | en_ZA |
| dc.identifier.chicagocitation | Ngandu, Nobubelo K, Debra Jackson, Carl Lombard, Duduzile F Nsibande, Thu-Ha Dinh, Vuyolwethu Magasana, Mary Mogashoa, and Ameena E Goga "Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014." (2019) http://hdl.handle.net/11427/30565 | en_ZA |
| dc.identifier.citation | BMC Infectious Diseases. 2019 Sep 16;19(Suppl 1):788 | |
| dc.identifier.ris | TY - Journal Article AU - Ngandu, Nobubelo K AU - Jackson, Debra AU - Lombard, Carl AU - Nsibande, Duduzile F AU - Dinh, Thu-Ha AU - Magasana, Vuyolwethu AU - Mogashoa, Mary AU - Goga, Ameena E AB - Abstract Background Since 2001 the South African guidelines to improve child health and prevent vertical HIV transmission recommended frequent infant follow-up with HIV testing at 18 months postpartum. We sought to understand non-attendance at scheduled follow-up study visits up to 18 months, and for the 18-month infant HIV test amongst a nationally representative sample of HIV exposed uninfected (HEU) infants from a high HIV-prevalence African setting. Methods Secondary analysis of data drawn from a nationally representative observational cohort study (conducted during October 2012 to September 2014) of HEU infants and their primary caregivers was undertaken. Participants were eligible (N = 2650) if they were 4–8 weeks old and HEU at enrolment. All enrolled infants were followed up every 3 months up to 18 months. Each follow-up visit was scheduled to coincide with each child’s routine health visit, where possible. The denominator at each time point comprised HEU infants who were alive and HIV-free at the previous visit. We assessed baseline maternal and early HIV care characteristics associated with the frequency of ‘Missed visits’ (MV-frequency), using a negative binomial regression model adjusting for the follow-up time in the study, and associated with missed visits at 18 months (18-month MV) using a logistic regression model. Results The proportion of eligible infants with MV was lowest at 3 months (32.7%) and 18 months (31.0%) and highest at 12 months (37.6%). HIV-positive mothers not on triple antiretroviral therapy (ART) by 6-weeks postpartum had a significantly increased occurrence rate of ‘MV-frequency’ (adjusted incidence rate ratio, 1.2 (95% confidence interval (CI), 1.1–1.4), p < 0.0001). Compared to those mothers with ART, these mothers also increased the risk of ‘18-month-MV’ (adjusted odds ratio, 1.3 (CI, 1.1–1.6), p = 0.006). Unknown infant nevirapine-intake status increased the rate of ‘MV-frequency’ (p = 0.02). Mothers > 24 years had a significantly reduced rate of ‘MV-frequency’ (p ≤ 0.01) and risk of ‘18-month-MV’ (p < 0.01) compared to younger women. Shorter travel time to health facility lowered the occurrence of ‘MV-frequency’ (p ≤ 0.004). Conclusion Late initiation of maternal ART and infant prophylaxis under the Option- A policy and extended travel time to clinics (measured at 6 weeks postpartum), contributed to higher postnatal MV rates. Mothers older than 24 years had lower MV rates. Targeted interventions may be needed during the current PMTCT Option B+ (lifelong ART to pregnant and lactating women at HIV diagnosis) to circumvent these risk factors and reduce missed visits during HIV-care. DA - 2019-09-16 DB - OpenUCT DP - University of Cape Town KW - HIV-exposed infants KW - Postnatal care KW - Missed visits LK - https://open.uct.ac.za PY - 2019 T1 - Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014 TI - Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014 UR - http://hdl.handle.net/11427/30565 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12879-019-4340-5 | |
| dc.identifier.uri | http://hdl.handle.net/11427/30565 | |
| dc.identifier.vancouvercitation | Ngandu NK, Jackson D, Lombard C, Nsibande DF, Dinh T, Magasana V, et al. Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014. 2019; http://hdl.handle.net/11427/30565. | en_ZA |
| dc.language.rfc3066 | en | |
| dc.rights.holder | The Author(s). | |
| dc.subject | HIV-exposed infants | |
| dc.subject | Postnatal care | |
| dc.subject | Missed visits | |
| dc.title | Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014 | |
| dc.type | Journal Article |