Journal of Reproductive Health, Gender, and HIV in Africa | 18 September 2003
A Scoping Review of Loss to Follow-up Rates and Predictors Among Pregnant Adolescents in the Prevention of Mother-to-Child Transmission Cascade in Blantyre, Malawi
C, h, i, k, o, n, d, i, B, a, n, d, a
Abstract
Adolescent pregnancy presents a significant public health challenge in sub-Saharan Africa, with particular concerns regarding engagement in prevention of mother-to-child transmission (PMTCT) programmes. Pregnant adolescents are highly vulnerable to loss to follow-up (LTFU), which compromises programme effectiveness and increases the risk of vertical HIV transmission. A focused understanding of this attrition in high-burden settings is essential. This scoping review aimed to map and synthesise existing evidence to determine the reported rates and identify the key predictors of LTFU among pregnant adolescents within PMTCT programmes in Blantyre, Malawi. A scoping review was conducted following established methodological frameworks. A systematic search was performed across relevant electronic databases. Included studies were those reporting LTFU rates or predictors for pregnant adolescents in the PMTCT cascade within Blantyre. Data were extracted and analysed thematically. The review identified a limited but consistent body of literature. Evidence indicated notably high LTFU rates among pregnant adolescents in this setting, with a major study reporting over 40% attrition at the point of infant HIV testing. Key predictors included fear of stigma and disclosure, lack of partner or family support, perceived poor quality of care, and logistical barriers such as transport costs. LTFU among pregnant adolescents in Blantyre’s PMTCT programmes was a pervasive issue, severely undermining the care cascade. The identified predictors are predominantly interrelated socio-structural and psychosocial factors. PMTCT programmes require adolescent-responsive strategies that directly address stigma, enhance counselling and partner engagement, and mitigate structural barriers. Further primary research is needed to develop and evaluate targeted interventions for improving retention in this vulnerable group. adolescent pregnancy, loss to follow-up, PMTCT, HIV, Malawi, retention, predictors. This review consolidates existing evidence on the magnitude and determinants of LTFU among pregnant adolescents in a key Malawian urban setting, providing a basis for designing more effective, adolescent-centred PMTCT services.