Retention in care of HIV‐infected pregnant and lactating women starting ART under Option B+ in rural Mozambique. Issue 8 (14th June 2016)

• Record Type: Journal Article
• Authors: Llenas‐García, Jara; Wikman‐Jorgensen, Philip; Hobbins, Michael; Mussa, Manuel Aly; Ehmer, Jochen; Keiser, Olivia; Mbofana, Francisco; Wandeler, Gilles
• Is Part Of: Tropical medicine & international health. Volume 21:Issue 8(2016)
• Page Start: 1003
• Page End: 1012
• Publication Date: 2016-06-14
• Subjects: Option B+ -- prevention of mother‐to‐child transmission -- HIV -- retention in care -- rural Southern Africa -- women's health; Option B+ -- PTME -- VIH -- rétention dans les soins -- zone rurale -- Afrique du Sud -- santé des femmes; Opción B+ -- prevención de la transmisión madre‐hijo -- VIH -- retención en cuidados -- sur de África rural -- salud de la mujer; Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12728
• Languages: English
• ISSNs: 1360-2276

Abstract

Abstract: 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.