Lost and linked to care: a 6-year longitudinal default tracking program of a cohort of infants exposed to HIV in Western Jamaica

• Published in: Vulnerable children and youth studies 2021-01, Vol.16 (1), p.38-49
• Main Authors: Williams, Shelly-Ann, Evans-Gilbert, Tracy, Reid, Gail, Campbell-Stennett, Dianne
• Format: Article
• Language: English
• Subjects: Breastfeeding & lactation; Children; Default; default tracking; HIV; Human immunodeficiency virus; Infants; infants exposed to HIV; Infections; Intervention; Sick role; vertical transmission
• ISSN: 1745-0128; 1745-0136
• DOI: 10.1080/17450128.2020.1762956

Evidence-based interventions are urgently needed to successfully achieve the elimination of mother to child transmission of HIV. This study aimed to evaluate the impact of a default tracking programme on the outcomes of infants exposed to HIV. We conducted a longitudinal cohort study of mothers infected with HIV. We established a default tracking programme for HIV-infected mother-infant pairs using a multidisciplinary team with clear lines of responsibilities. Infants exposed to HIV who did not return for the assessment of their infection status were defined as 'defaulters'. The defaulters were tracked and classified as linked to care or 'lost to follow-up' (LTFU) if they were not re-engaged in care. Within the study cohort, we investigated LTFU at 6 weeks, 4 months, and 18 months, linkage-to-care, and laboratory outcomes. Between 2012 and 2017, there were 454 live-births, 25 transfers, 2 deaths, 8 cases of HIV infection, 136 defaulters, and 68 infants LTFU. The number of children who defaulted care reduced from 44% in 2012 to 7% in 2017 (p = 0.0001)). Infants LTFU reduced significantly from 21% to 4% (p = 0.0001). The prevalence of negative PCR1 increased significantly from 75% to 97% (p = 0.002), while that for positive PCR declined from 4% to 0%. The seroconversion rate was 1.9%. Of the 68 infants LTFU among the entire cohort, 18 (4%) were lost at 6 weeks, 14 (3%) at 4 months, and 36 (9%) at 18 months (p = 0.025). Thirty-four of the LFTU (97%) at 18 months tested negative for PCR1, and 31 (89%) tested negative for PCR 2. Three defaulters that were linked-to-care had HIV infection. Multidisciplinary service packages and the tracking of mother-infant pairs who default from care had a positive impact on reducing LTFU and increasing PCR uptake in this non-breastfeeding population.