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

Bibliographic Data

ID23346843
AuthorsLyson Tenthani (University of Bern, corresponding author), Andreas D Haas (0000-0002-4849-181X, University of Bern, corresponding author), Hannock Tweya (0000-0002-8247-1273, University of Bern), Andreas Jahn (0000-0001-8181-9795, University of Washington), Joep J van Oosterhout (0000-0002-3441-0804, Dignitas International), Frank Chimbwandira (Ministry of Health), Zengani Chirwa (University of Washington), Wingston Ng’ambi (Lighthouse Trust), Alan Bakali, Sam Phiri (0000-0002-9372-212X, Lighthouse Trust), Landon Myers (0000-0002-8106-7658, University of Cape Town), Landon Myer, Fabio Valeri (0000-0002-2481-9737, University of Bern), Marcel Zwahlen (0000-0002-6772-6346, University of Bern), Gilles Wandeler (0000-0002-5278-8763, University of Bern), Olivia Keiser (0000-0001-8191-2789, University of Bern, corresponding author)
Year2014
Volume28
Issue4
Pages589-598
Publication date2014-02-20
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAIDS (JOURNAL)
Journal identifiersISSN: 0269-9370 • E-ISSN: 1473-5571
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/qad.0000000000000143
PMID24468999
PMCIDPMC4009400
OpenAlexW2039836366
LanguageEN
Citations received56
References cited17

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.

Antiretroviral therapy · Breast feeding · Breastfeeding · Confidence interval · Family medicine · Human immunodeficiency virus (HIV) · Obstetrics · Odds ratio · Pregnancy · Psychological intervention · Viral load · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Internal Medicine · Medicine · Mobile Health and mHealth Applications · Nursing · Pediatrics