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AIDS. 2014 Feb 20;28(4):589-598. doi: 10.1097/QAD.0000000000000143.

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

Author information

1
Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
2
Institute of Social and Preventive Medicine, University of Bern, Switzerland.
3
International Training and Education Centre for Health / Department for Global Health, University of Washington, Seattle, USA.
4
Lighthouse Trust Clinic, Lilongwe, Malawi.
5
The International Union Against Tuberculosis and Lung Disease, Paris, France.
6
Dignitas International, Zomba, Malawi.
7
Baobab Trust, Lilongwe, Malawi.
8
Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, South Africa.
9
Department of Infectious Diseases, University Hospital Bern, Switzerland.
#
Contributed equally

Abstract

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.

PMID:
24468999
PMCID:
PMC4009400
DOI:
10.1097/QAD.0000000000000143
[Indexed for MEDLINE]
Free PMC Article
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