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Home >> Publications >> Retention in care of HIV-infected pregnant and lactating women starting ART under Option B+ in rural Mozambique.

Publication

Author(s):

Llenas-García J1, Wikman-Jorgensen P1, Hobbins M2, Mussa MA3, Ehmer J2, Keiser O4, Mbofana F5, Wandeler G4,6; SolidarMed and IeDEA-Southern Africa.

Pub Title:

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

Pub Date:

Aug 1 2016

Pub Region(s):

Southern Africa

Journal:

Title: 
Trop Med Int Health
Link: 
http://onlinelibrary.wiley.com/doi/10.1111/tmi.12728/abstract;jsessionid=D4485A8884D0744D46775B71F417BFB1.f03t03

PubMed: 27208807
Pub PDF:

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 analysed 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 according to 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 centre), age, WHO stage and time from HIV diagnosis to ART.

RESULTS: Over 333 person-years of follow-up (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 centre was the only additional significant risk factor for loss to follow-up.

CONCLUSIONS: Retention among PLW starting option B+ ART was poor and mainly driven by early losses. 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 counselling and retention measures, especially at the beginning of treatment.

 

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Citation:

Trop Med Int Health. 2016 Aug;21(8):1003-1012. doi: 10.1111/tmi.12728. Epub 2016 Jun 14. Retention in care of HIV-infected pregnant and lactating women starting ART under Option B+ in rural Mozambique. Llenas-García J1, Wikman-Jorgensen P1, Hobbins M2, Mussa MA3, Ehmer J2, Keiser O4, Mbofana F5, Wandeler G4,6; SolidarMed and IeDEA-Southern Africa.