Factors Associated with the Retention in Care After Delivery among Thai Mothers with HIV

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Thiwarphorn Chalermpichai
Ameporn Ratintorn
Siriorn Sindhu
Winai Ratanasuwan
Nancy Reynolds


           The objectives of this retrospective cross-sectional study were to investigate the prevalence and predictive factors in retention of care during the first year after delivery among Thai mothers with HIV. The sample consisted of 185 mothers with HIV infection who gave birth at a public hospital from January 2010 to December 2012. Recruitment and enrollment took place from March - July 2014. Data were collected through self-administered questionnaires and telephone interviews by using 5 questionnaires: the Personal Information, Access to Health Care, Receiving HIV Care, Attitudes toward Health Care Providers, and Short Form-HIV Stigma Scale. Data were analyzed using descriptive statistics and logistic regression analyses.
             Results showed that 77.3% of the participants were retained in care at the HIV clinics with 46.5% at obstetric and gynecology clinics. The results of logistic regression analysis revealed that the predictive factors of retention in care at HIV clinics explained 80% of the variance. The factors predictive of retention in care at obsetetric and gyne­cology clinics were official referral and disclosure of HIV status. These factors explained 14% of the variance of retention in care at these clinics.
               The results suggest that health care providers should have an effective system to refer patients to their registered hospital and improve benefits of health coverage to be relevant to patients’ need. In addition, the management of HIV care should address the individual patient's self-disclosure. 

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How to Cite
Chalermpichai T, Ratintorn A, Sindhu S, Ratanasuwan W, Reynolds N. Factors Associated with the Retention in Care After Delivery among Thai Mothers with HIV. PRIJNR [Internet]. 2016 Jul. 11 [cited 2022 Sep. 27];20(3):225-37. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/47305
Original paper


1. Bureau of Epidemiology. National trustworthy and competent authority in epidemiological surveillance and investigation. Department of Disease Control, Ministry of Public Health: Bureau of Epidemiology; 2014 [updated November, 2012; cited 2014 October 25]; Available from: https://www.boe.moph.go.th/report.php?cat= 19&id=1268.

2. World Health Organisation. WHO traditional medicine strategy 2002-2005. WHO/EDM/TRM/2002.1. 2002.

3. Rubaihayo J, Tumwesigye NM, Konde-Lule J. Trends in prevalence of selected opportunistic infections associated with HIV/AIDS in Uganda. BMC Infectious Diseases. 2015;15:187. BMC Infectious Diseases. 2015;15(187).

4. Boubouchairopoulou N, Athanasakis K, Chini M, Mangafas N, Lazanas MK, Kyriopoulos JE. Estimation of the direct cost of HIV-infected patients in Greece on an annual basis. Value in Health Regional. 2014(4C):82-6.

5. Chalermpichai T, Ratinthorn A, Serisathien Y, Boriboonhirunsarn D. Prevalence of loss to postpartum follow-up in mothers with HIV infection and associated factors. Thai Journal of Nursing Council. 2008;23(1):4858.

6. Kongyu S. Quality of life of postpartum mothers with HIV, Phetchaburi and Ratchaburi province: Master of Science (Epidemiology) Faculty of Graduate Studies, Mahidol University; 2006.

7. Helleberg M, Engsig FN, Kronborg G, Larsen CS, Pedersen G, Pedersen C, et al. Retention in a public healthcare system with free access to treatment: A Danish nationwide HIV cohort study. AIDS. 2012;26(6):741-8.

8. Yehia BR, Stewart L, Momplaisir F, Mody A, Holtzman CW, Jacobs LM, et al. Barriers and facilitators to patient retention in HIV care. BMC Infectious Diseases. 2015;15(1):1-10.

9. World Health Organisation. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. 2010.

10. Social Security Office. Social Security Welfare. 2011 [cited 2011 May 15,2011]; Available from: www.tu. ac.th/org/ofrector/person/welfare/soci.htm.

11. Cunningham WE, Andersen RM, Katz MH, Stein MD, Turner BJ, Crystal S, et al. The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Medical Care. 1999;37(12): 1270-81.

12. Himakalasa W, Grisurapong S, Phuangsaichai S. Access to antiretroviral therapy among HIV/AIDS patients in Chiang Mai province, Thailand HIV/AIDS – Research and Palliative Care. 2013;5:205-13.

13. Songwathana P. Advanced nursing for caring of people living with HIV/AIDS in HAART era. Songkhla: Chanmuang; 2011.

14. Esquivel A. Characterizing, assessing and improving healthcare referral communication. Houston: Degree of Doctor of Philosophy, The University of Texas School of Health Information Sciences at Houston; 2008.

15. Bodenlos JS, Grothe KB, Kendra K, Whitehead D, Copeland AL, Brantley PJ. Attitudes toward HIV health care providers scale: Development and validation. AIDS Patient Care and STDs. 2004;18(12):714-20.

16. Kempf M, McLeod J, Boehme AK, Walcott MW, Wright L, Seal P, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural Southeastern United States: Implications for targeted interventions. AIDS Patient Care & STDs. 2010;24(8):515-20.

17. Hanh NTT, Rasch V, Chi BK, Gammeltoft T. Posttest counseling and social support from health staff caring for HIV-infected pregnant women in Vietnam. Journal of the Association of Nurses in AIDS Care. 2009;20(3):193-202.

18. Adebayo SB, Fakolade R, Anyanti J, Ekweremadu B, Ladipo O, Ankomah A. Modelling level, trend and geographical variations in stigma and discrimination against people living with HIV/AIDS in Nigeria. SAHARA-J: Journal of Social Aspects of HIV/AIDS. 2011;8(3):115-27.

19. Genberg BL, Kawichai S, Chingono A, Sendah M, Chariyalertsak S, Konda KA, et al. Assessing HIV/AIDS stigma and discrimination in developing countries. AIDS and Behavior. 2008;12:772-80.

20. Fongkaew W, Viseskul N, Suksatit B, Settheekul S, Chontawan R, Grimes RM, et al. Verifying quantitative stigma and medication adherence scales using qualitative methods among Thai youth living with HIV/AIDS. Journal of the International Association of Physicians in AIDS Care (JIAPAC). 2013.

21. Layer EH, Kennedy CE, Beckham SW, Mbwambo JK, Likindikoki S, Davis WW, et al. Multi-level factors affecting entry into and engagement in the HIV continuum of care in Iringa, Tanzania. PLoS ONE. 2014;9(8): e104961.

22. Speake DL, Cowart ME, Pellet K. Health perceptions and lifestyles of the elderly. Research in Nursing & Health. 1989;12:93-100.

23. Department of Disease Control. Thailand national guidelines on HIV/AIDS treatment and prevention 2014. Nonthaburi: Agricultural Cooperative Federation of Thailand; 2014.

24. Patumanond J. Medical epidemiology. Chiangmai: PHRCG; 1998.

25. Sayles J, Wong M, Kinsler J, Martins D, Cunningham W. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. Journal of General Internal Medicine. 2009;24(10):1101-8.

26. Waltz CF, Strickland OL, Lenz ER. Measurement in nursing and health research 3rd ed. New York: Springer; 2005.

27. Maneesriwongul W. Assessment of healthcare needs among persons receiving antiretroviral therapy. Bangkok. (In Thai). 2013.

28. Rana AI, Gillani FS, Flanigan TP, Nash BT, Beckwith CG. Follow-up care among HIV-infected pregnant women in Mississippi. Journal of Women’s Health. 2010;19(10): 1863-7.

29. Braitstein P, Siika A, Hogan J, Kosgei R, Sang E, Sidle J, et al. A clinician-nurse model to reduce early mortality and increase clinic retention among high-risk HIV-infected patients initiating combination antiretroviral treatment. Journal of the International AIDS Society. 2012;15(7).

30. Magnus M, Herwehe J, Murtaza-Rossini M, Reine P, Cuffie D, Gruber D, et al. Linking and retaining HIV patients in care: The importance of provider attitudes and behaviors. AIDS Patient Care & STDs. 2013;27(5):297-303.

31. Horne R, Cooper V, Gellaitry G, Date HL, Fisher M. Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: The utility of the necessity-concerns framework. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2007;45(3): 334-41.

32. Leung SSK, Leung I. Cervical cancer screening: knowledge, health perception and attendance rate among Hong Kong Chinese women. International Journal of Women’s Health. 2010;2:221-8.

33. Duff P, Kipp W, Wild TC, Rubaale T, Okech-Ojony J. Barriers to accessing highly active antiretroviral therapy by HIV-positive women attending an antenatal clinic in a regional hospital in western Uganda. Journal of the International AIDS Society. 2010;13(37).

34. Wachira J, Naanyu V, Genberg B, Ndege S, Siika AM, Kimayo S, et al. Perceived health facility barriers to HIV linkage and retention in western Kenya. BMC Infectious Diseases. 2014;14(Suppl 2):30.

35. Chen YC, Lai YY, Liu HY, Pai YH, Ko WC, Ko NY. The impact of nurse-led case management on the quality of HIV care. HU Li Za Zhi The Journal of Nursing. 2014; 61(3):69-78.

36. Tominari S, Nakakura T, Yasuo T, Yamanaka K, Takahashi Y, Shirasaka T, et al. Implementation of mental health service has an impact on retention in HIV care: A nested case-control study in a Japanese HIV care facility. PLoS ONE. 2013;8(7): e69603.

37. Lifson AR, Demissie W, Tadesse A, Ketema K, May R, Yakob B, et al. Barriers to retention in care as perceived by persons living with HIV in rural Ethiopia: Focus group results and recommended strategies. Journal of the International Association of Providers of AIDS Care. 2013;12(1):32-8.

38. Maluleke TX, Manganye BS, Lebese RT. Perceptions of professional nurses in rural hospitals of the Limpopo province regarding nursing care of patients with human immunodeficiency virus and acquired immunodeficiency syndrome. Journal of AIDS Clinical Research 2012;3(8).

39. Holzemer WL, Uys L, Makoae L, Stewart A, Phetlhu R, Dlamini PS, et al. A conceptual model of HIV/AIDS stigma from five African countries. Journal of Advanced Nursing. 2007;58(6):541-51.

40. Mazor KM, Clauser BE, Field T, Yood RA, Gurwitz JH. A demonstration of the impact of response bias on the results of patient satisfaction survey. Health Service Research. 2002;37(5):1403-17.

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