Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+') in Malawi.
- Tenthani L Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
- Haas AD Institute of Social and Preventive Medicine, University of Bern, Switzerland.
- Tweya H Institute of Social and Preventive Medicine, University of Bern, Switzerland.
- Jahn A Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
- van Oosterhout JJ Dignitas International, Zomba, Malawi.
- Chimbwandira F Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
- Chirwa Z Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
- Ng'ambi W Lighthouse Trust Clinic, Lilongwe, Malawi.
- Bakali A Baobab Trust, Lilongwe, Malawi.
- Phiri S Lighthouse Trust Clinic, Lilongwe, Malawi.
- Myer L Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, South Africa.
- Valeri F Institute of Social and Preventive Medicine, University of Bern, Switzerland.
- Zwahlen M Institute of Social and Preventive Medicine, University of Bern, Switzerland.
- Wandeler G Institute of Social and Preventive Medicine, University of Bern, Switzerland.
- Keiser O Institute of Social and Preventive Medicine, University of Bern, Switzerland.
- 2014-01-29
Published in:
- AIDS (London, England). - 2014
Adolescent
Adult
Anti-Retroviral Agents
Antiretroviral Therapy, Highly Active
Breast Feeding
Female
HIV Infections
Health Services Research
Humans
Lost to Follow-Up
Malawi
Middle Aged
Pregnancy
Pregnancy Complications, Infectious
Young Adult
English
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.
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.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1097/QAD.0000000000000143
- PMID 24468999
- Persistent URL
- https://sonar.ch/global/documents/219053
Statistics
Document views: 53
File downloads:
- Full-text: 0