Facilitators and barriers to retention in care under universal antiretroviral therapy (Option B+) for the Prevention of Mother to Child Transmission of HIV (PMTCT): A narrative review

Mother to child transmission remains the primary source of HIV in children. In 2013, The World Health Organisation (WHO), recommended Option B+ as prevention of mother to child transmission (PMTCT) strategy in Low and Middle-income Countries. With this strategy, all HIV positive pregnant and lactating women are initiated on lifelong antiretroviral therapy (ART) regardless of their clinical and immunological status. Despite, Option B+ contributing significantly to the reduction of new HIV infection in children, non-retention in care remains the primary bottleneck. The aim of the review was, therefore, to synthesise the evidence around facilitators and barriers to Option B+ retention by HIV positive mothers. This review consisted of an online literature search in electronic databases including CINAHL, Medline, EMBASE, PsycINFO, BNI, Web of Science, Latin America and Caribbean Health Sciences Literature (LILAC) and PubMed. The Identified papers were critically appraised using the Mixed Method Appraisal Tool (MMAT). A narrative synthesis method was used to synthesize review results. The review included 37 papers, mostly published in sub-Saharan Africa. The review established that risk factors for non-retention in PMTCT include young age (15–24 years), initiating mothers on antiretroviral therapy on the same day as diagnosis, lack of disclosure, anticipated stigma, hospital factors, and concerns about side effects. The review suggests that younger women are more susceptible to non-retention in PMTCT. Efforts should be made to develop interventions to retain young mothers in PMTCT to reach zero new infection in children and to protect the health of mothers.