Missed initial clinic visits among women living with HIV in the transition from maternal and child health clinics to general HIV care clinics in western Kenya

Abstract

Women living with HIV (WLHIV) of reproductive age transfer their HIV care from general HIV care clinics to maternal and child health (MCH) clinics during pregnancy or breastfeeding to access prevention of mother to child transmission (PMTCT) services. Upon cessation of breastfeeding, they transition back to the general HIV care clinics to continue routine follow up. Studies in parts of sub-Saharan Africa have reported that up to 25% of WLHIV miss their clinic visits during the transition from the MCH to the general HIV care clinic. Our primary aim was to estimate the prevalence and correlates of missed initial clinic visit at the general HIV care clinic after planned transition from the MCH clinic among WLHIV in Homabay county, Kenya.Between January 2024 and March 2024, we enrolled 152 WLHIV and 20 health care workers (HCWs) from three Ministry of Health clinics in Homabay county, Kenya. WLHIV were eligible if they were 1) aged 15 and above, 2) HIV positive and on antiretroviral treatment (ART) and 3) were scheduled to transition their HIV care to the general HIV care clinic after completing PMTCT follow up. For the WLHIV we used a prospective cohort study design with one follow up visit. At baseline we collected demographic data, screened for depression and intimate partner violence, and abstracted clinical data from participant records. The follow up visit was conducted two weeks after the appointment date at the general HIV care clinic where we assessed clinic attendance at the general HIV care clinic and recoded any barriers or facilitators to clinic attendance. For the HCWs we administered a cross-sectional survey that explored patient barriers to clinic attendance during this transition. We conducted univariate analysis using logistic regression to calculate relative risk (RR) of binary correlates, clustered by clinic. Additionally, we performed multivariate analysis calculating the adjusted relative risk (aRR) for depression, age group and ART initiation relative to the first trimester of the current pregnancy, also clustered by clinic. Data from the cross-sectional healthcare worker survey was summarized into thematic areas and presented in a table. In univariate analysis, Age <25 years and ART initiation after the first trimester of current pregnancy were associated with a 2.64-fold (RR 2.64, 95% CI: 2.02, 3.46, P=<0.001) and 86% (RR 1.86, 95% CI (1.37, 2.53, P=<0.001) higher likelihood of missing the initial clinic visit at the general HIV care clinic respectively. In multivariate analysis, age <25 years and ART initiation after the first trimester of the current pregnancy were associated with a 2.71-fold (aRR 2.71, CI 2.27, 3.24, p<0.001) and an 90% (aRR1.90, CI 1.34, 2.69, p<0.001) higher likelihood of missing the initial clinic visits. In conclusion, a significant proportion, especially young women and women newly on ART, miss their initial clinic visit at general HIV care clinic after planned transition from MCH post PMTCT. A structured approach to transitioning WLHIV out of MCH is necessary.