Factors associated with interruption in treatment among pregnant and breastfeeding women living with HIV on ART in South Sudan

BACKGROUND: Continuity of HIV treatment among pregnant and breastfeeding women (PBFW) living with HIV is challenging in South Sudan. Understanding factors associated with interruption in treatment (IIT) among PBFW on antiretroviral therapy (ART) may inform programmatic interventions to improve care and continuity of treatment. METHODS: A retrospective cohort analysis of records of PBFW on ART in twenty health facilities was conducted. A probability-proportionate-to-size sampling (PPS) method was used to select facilities with PBFW on ART for at least six months from 01/10/2019 to 01/02/2022 prior to date of data abstraction. Demographic and clinical information were abstracted from facility-based registers and client files. Abstracted ART visit data were used to calculate IIT, and multi-month dispensing (MMD) of ART. Prevalence ratios (PRs) were used to calculate measures of association for IIT. RESULTS: A total of 1,478 PBFW on ART were included; 37% had IIT. Home delivery compared to facility delivery (Adj.PR = 1.3, 95% C.I: 1.04–1.49) and receiving MMD for < 3 months compared to ≥ 6 months (Adj.PR = 1.6, 95% C.I: 1.30–2.00) were significantly associated with IIT among PBFW. Those attending one Antenatal Care (ANC) visit compared to ≥ 3 (Adj.PR = 0.8, 95% CI: 0.66–0.96) were less likely to have IIT. CONCLUSIONS: Over one-third of PBFW on ART had IIT, which was associated with three factors: number of ANC visits, place of delivery, and frequency of MMD. MMD for PBFW was not associated with IIT, supporting its use in areas with similar challenges to South Sudan.