Factores associados a retenção de mulheres em cuidados e tratamentos do HIV antes e depois do parto no distrito de Manhiça e Matola, Província de Maputo em Moçambique de 2017 à 2020

Abstract

Introduction: Access to HIV care and treatment are key to ending this disease as a public health threat.. There are still challenges in terms of patient losses, the average retention of pregnant women was 94% for 3 months in 2022. This study aimed to assess the factors associated with retention of women in HIV care and treatment before and after delivery. Methodology: A cross-sectional study was conducted using secondary data from pregnant women and mothers from 2017 to 2020 in the Manhiça and Matola Districts, Maputo Province in Mozambique using the MozART (Mozambique Antiretroviral Therapy) database. Independent variables of pregnant women and mothers were selected, such as age, marital status, level of education, profession, pregnancy, number of children, number of cohabitants, tobacco, drugs, alcohol, freezer, electricity, PMTCT and clinical history. The retention variable was categorized as retained and not retained and was considered the dependent variable.A univariate logistic regression analysis was conducted to estimate the odds ratios (OR) of the independent variables on retention at 3 and 6 months before and after delivery. Results: Of the 1,404 women, the median age was 25, with a minimum of 15 and a maximum of 47. Of the women, 80.3% (1,127/1,404) were between 20 and 34 years old, 68.5% (962/1,404) were domestic workers, 46.8% had between 0 and 2 children and ulcer was the most common STD with 13.2% (185/1,404). At 6 months before delivery, the districts of Matola and Manhiça had retention rates of 83% and 79% and at 6 months after delivery 50% and 61%.Factors such as having two to three cohabitants in the household were associated with non-retention at 6 months before delivery [AOR: 0.63; 95% CI (0.40-1.00), p= 0.050] versus having no cohabitants. Having no children [AOR: 5.46; 95% CI (1.32-17.59), p= 0.019], having 0-2 children [AOR: 44.41; 95% CI (1.25-15.47), p= 0.020] and 3-4 children [AOR: 4.45; 95% CI (1.30-10.82), p= 0.018] were associated with retention at three months before childbirth versus having more than 5 children. Not having energy in women's homes [AOR: 0.58; 95% CI (0.35-0.95), p= 0.031] was associated with non-retention at three months before childbirth versus having energy. Not being on PMTCT was associated with non-retention at 3 months before delivery [AOR: 0.60; 95% CI (0.46 -0.88), p< 0.001] versus being on PMTCT. Characteristics such as living in Matola District were associated with non-retention at 3 months after delivery [AOR: 0.67; 95% CI (0.45-0.99), p= 0.048] and at 6 months after delivery [AOR: 0.69; 95% CI (0.50-0.98), p= 0.040] versus living in Manhiça District. Conclusion: In Matola District there was a decline in retention rates from 83% to 50% and in Manhiça District from 76% to 61% compared to retention before delivery, which confirmed that women were more likely to adhere to HIV care and treatment during pregnancy than postpartum. The chance of a woman being retained increased in childles women.Interventions for HIV-infected pregnant women and mothers can generally include retention education using lectures, motivational text messages more widely in communities and systematic tracking of women who abandon to HIV care and treatment.