Incidence of Home Delivery Among Women Living With HIV in Lira, Northern Uganda: A Prospective Cohort Study

Abstract Introduction Facility delivery is one of the interventions recommended in the context of HIV to reduce on the risk of mother-to-child transmission of HIV. Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda. Methods This prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women were enrolled and followed up at delivery. We used a structured questionnaire to obtain data on socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for home delivery. Results The incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9% - 9.5%). Women who were most likely to deliver at home were single mothers (adjusted risk ratio = 4.39, 95%CI: 1.68 – 11.42). Women who experienced night time onset of labour (adjusted risk ratio =0.4, 95%CI: 0.18 – 0.87) and women who were adherent to their ART were more likely to deliver in the hospital (adjusted risk ratio=0.33, 95%CI: 0.13 – 0.86). Conclusion HIV infected women most likely to deliver at home were single mothers. Women whose labour started at night and those who were adherent to their ART were more likely to deliver in the hospital. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for single women and those not adherent to their ART.