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Int Health. 2015 Nov;7(6):405-11. doi: 10.1093/inthealth/ihv032. Epub 2015 May 25.

Pregnant women with HIV in rural Nigeria have higher rates of antiretroviral treatment initiation, but similar loss to follow-up as non-pregnant women and men.

Author information

1
Vanderbilt Institute for Global Health Departments of Health Policy muktar.aliyu@vanderbilt.edu.
2
Vanderbilt Institute for Global Health Department of Biostatistics.
3
Westat, Rockville, MD, USA.
4
Vanderbilt Institute for Global Health Departments of Health Policy.
5
Vanderbilt Institute for Global Health Department of Human and Organizational Development.
6
Department of Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-400, Nashville, TN 37203, USA.
7
Friends for Global Health Initiative, Abuja, Nigeria.
8
Vanderbilt Institute for Global Health Department of Medicine.
9
Vanderbilt Institute for Global Health Department of Pediatrics, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN 37203, USA.

Abstract

BACKGROUND:

We examined antiretroviral therapy (ART) initiation and retention by sex and pregnancy status in rural Nigeria.

METHODS:

We studied HIV-infected ART-naïve patients aged ≥15 years entering care from June 2009 to September 2013. We calculated the probability of early ART initiation and cumulative incidence of loss to follow-up (LTFU) during the first year of ART, and examined the association between LTFU and sex/pregnancy using Cox regression.

RESULTS:

The cohort included 3813 ART-naïve HIV-infected adults (2594 women [68.0%], 273 [11.8%] of them pregnant). The proportion of pregnant clients initiating ART within 90 days of enrollment (78.0%, 213/273) was higher than among non-pregnant women (54.3%,1261/2321) or men (53.0%, 650/1219), both p<0.001. Pregnant women initiated ART sooner than non-pregnant women and men (median [IQR] days from enrollment to ART initiation for pregnant women=7 days [0-21] vs 14 days [7-49] for non-pregnant women and 14 days [7-42] for men; p<0.001). Cumulative incidence of LTFU during the first year post-ART initiation was high and did not differ by sex and pregnancy status. Persons who were unemployed, bedridden, had higher CD4+ counts, and/or in earlier WHO clinical stages were more likely to be LTFU.

CONCLUSIONS:

Pregnant women with HIV in rural Nigeria were more likely to initiate ART but were no more likely to be retained in care. Our findings underscore the importance of effective retention strategies across all patient groups, regardless of sex and pregnancy status.

KEYWORDS:

Antiretroviral therapy; HIV/AIDS; Loss to follow-up; Nigeria; Retention in care

PMID:
26012740
PMCID:
PMC4654753
DOI:
10.1093/inthealth/ihv032
[Indexed for MEDLINE]
Free PMC Article

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