Retention in care of HIV-infected pregnant and lactating women starting art under Option B+ in rural Mozambique.

Llenas-García, Jara; Wikman-Jorgensen, Philip; Hobbins, Michael; Mussa, Manuel Aly; Ehmer, Jochen; Keiser, Olivia; Mbofana, Francisco; Wandeler, Gilles (2016). Retention in care of HIV-infected pregnant and lactating women starting art under Option B+ in rural Mozambique. Tropical medicine and international health TM&IH, 21(8), pp. 1003-1012. Blackwell Science 10.1111/tmi.12728

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OBJECTIVE In 2013, Mozambique adopted Option B+, universal lifelong antiretroviral therapy (ART) for all pregnant and lactating women, as national strategy for prevention of mother-to-child transmission of HIV. We analyzed retention in care of pregnant and lactating women starting Option B+ in rural northern Mozambique. METHODS We compared ART outcomes in pregnant ("B+pregnant"), lactating ("B+lactating") and non-pregnant-non-lactating women of childbearing age starting ART after clinical and/or immunological criteria ("own health") between July 2013 and June 2014. Lost to follow-up was defined as no contact >180 days after the last visit. Multivariable competing risk models were adjusted for type of facility (type 1 vs. peripheral type 2 health center), age, WHO stage and time from HIV diagnosis to ART. RESULTS Over 333 person-years of follow-up (of 243 "B+pregnant", 65″B+lactating" and 317 "own health" women), 3.7% of women died and 48.5% were lost to follow-up. "B+pregnant" and "B+lactating" women were more likely to be lost in the first year (57% vs. 56.9% vs. 31.6%; p<0.001) and to have no follow-up after the first visit (42.4% vs. 29.2% vs. 16.4%; p<0.001) than "own health" women. In adjusted analyses, risk of being lost to follow-up was higher in "B+pregnant" (adjusted subhazard ratio [asHR]: 2.77; 95% CI: 2.18-3.50; p<0.001) and "B+lactating" (asHR: 1.94; 95% CI: 1.37-2.74; p<0.001). Type 2 health center was the only additional significant risk factor for loss to follow-up. CONCLUSIONS Retaining pregnant and lactating women in option B+ ART was poor; losses to follow-up were mainly early. The success of Option B+ for prevention of mother-to-child transmission of HIV in rural settings with weak health systems will depend on specific improvements in counseling and retention measures, especially at the beginning of treatment. This article is protected by copyright. All rights reserved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Keiser, Olivia and Wandeler, Gilles

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

1360-2276

Publisher:

Blackwell Science

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

08 Jun 2016 07:46

Last Modified:

10 Sep 2017 07:20

Publisher DOI:

10.1111/tmi.12728

PubMed ID:

27208807

Uncontrolled Keywords:

HIV ; PMTCT ; Option B+; retention in care; rural Southern Africa; women's health

BORIS DOI:

10.7892/boris.82651

URI:

https://boris.unibe.ch/id/eprint/82651

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