Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+') in Malawi

Tenthani, Lyson; Haas, Andreas D; Tweya, Hannock; Jahn, Andreas; van Oosterhout, Joep J.; Chimbwandira, Frank; Chirwa, Zengani; Ng'ambi, Wingston; Bakali, Alan; Phiri, Sam; Myer, Landon; Valeri, Fabio; Zwahlen, Marcel; Wandeler, Gilles; Keiser, Olivia (2014). Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+') in Malawi. AIDS, 28(4), pp. 589-98. Lippincott Williams & Wilkins 10.1097/QAD.0000000000000143

Preview

Text Tenthani AIDS 2014.pdf - Published Version Available under License Publisher holds Copyright. Download (1MB) | Preview

OBJECTIVE

To explore the levels and determinants of loss to follow-up (LTF) under universal lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') in Malawi.

DESIGN, SETTING, AND PARTICIPANTS

We examined retention in care, from the date of ART initiation up to 6 months, for women in the Option B+ program. We analysed nationwide facility-level data on women who started ART at 540 facilities (n = 21 939), as well as individual-level data on patients who started ART at 19 large facilities (n = 11 534).

RESULTS

Of the women who started ART under Option B+ (n = 21 939), 17% appeared to be lost to follow-up 6 months after ART initiation. Most losses occurred in the first 3 months of therapy. Option B+ patients who started therapy during pregnancy were five times more likely than women who started ART in WHO stage 3/4 or with a CD4 cell count 350 cells/μl or less, to never return after their initial clinic visit [odds ratio (OR) 5.0, 95% confidence interval (CI) 4.2-6.1]. Option B+ patients who started therapy while breastfeeding were twice as likely to miss their first follow-up visit (OR 2.2, 95% CI 1.8-2.8). LTF was highest in pregnant Option B+ patients who began ART at large clinics on the day they were diagnosed with HIV. LTF varied considerably between facilities, ranging from 0 to 58%.

CONCLUSION

Decreasing LTF will improve the effectiveness of the Option B+ approach. Tailored interventions, like community or family-based models of care could improve its effectiveness.

Interest & Impact

Downloads

588 since deposited on 15 Feb 2014
30 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item