Exploring loss to follow-up among women living with HIV in Prevention of Mother to Child Transmission programmes in Côte d'Ivoire

The expansion of Prevention of Mother to Child Transmission (PMTCT) services globally has been accompanied by significant rates of loss to follow-up (LTFU). This study explored barriers and facilitators to participation in PMTCT programmes for pregnant and post-partum women living with HIV who had been LTFU at public sector antenatal care facilities in the Vallée du Bandama region of Côte d'Ivoire, West Africa. Three types of interviews were conducted at seven health sites: (1) individual or small group interviews with health staff; (2) one focus group with women actively enrolled in PMTCT services; and (3) individual interviews with women who had been LTFU from PMTCT services. Ten main themes emerged and were classified within a modified social ecological model. The individual level barriers included discouragement and internalised stigma, while hope for self/child's health was a facilitator. The family/community level barriers were fear of stigma and gender inequities. The health system level barriers were unclear information and poor post-test counselling, while staff advice and support groups were facilitators. The structural level barrier was associated costs. Factors on all four levels of the social ecological model must be addressed in order to maximise adherence to PMTCT services.