Implementation and Operational Research: The Impact of Option B+ on the Antenatal PMTCT Cascade in Lilongwe, Malawi. (15th April 2015)

• Record Type: Journal Article
• Authors: Kim, Maria H.; Ahmed, Saeed; Hosseinipour, Mina C.; Giordano, Thomas P.; Chiao, Elizabeth Y.; Yu, Xiaoying; Nguyen, Chi; Chimbwandira, Frank; Kazembe, Peter N.; Abrams, Elaine J.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 68:Number 5(2015)
• Publication Date: 2015-04-15
• Subjects: HIV -- PMTCT -- Option B+ -- retention -- Malawi -- Africa; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000000517
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Objective: In 2011, Malawi implemented Option B+ (B+), lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women. We aimed to describe changes in service uptake and outcomes along the antenatal prevention of mother-to-child transmission (PMTCT) cascade post-B+ implementation. Design: Pre/post study using routinely collected program data from 2 large Lilongwe-based health centers. Methods: We compared the testing of HIV-infected pregnant women at antenatal care, enrollment into PMTCT services, receipt of ART, and 6-month ART outcomes pre-B+ (October 2009–March 2011) and post-B+ (October 2011–March 2013). Results: A total of 13, 926 (pre) and 14, 532 (post) women presented to antenatal care. Post-B+, a smaller proportion were HIV-tested (99.3% vs. 87.7% post-B+; P < 0.0001). There were 1654 (pre) and 1535 (post) HIV-infected women identified, with a larger proportion already known to be HIV-infected (18.1% vs. 41.2% post-B+; P < 0.0001) and on ART post-B+ (18.7% vs. 30.2% post-B+; P < 0.0001). A significantly greater proportion enrolled into the PMTCT program (68.3% vs. 92.6% post-B+; P < 0.0001) and was retained through delivery post-B+ (51.1% vs. 65% post-B+; P < 0.0001). Among those not on ART at enrollment, there was no change in the proportion newly initiating ART/antiretrovirals (79% vs. 81.9% post-B+; P = 0.11), although median days to initiation of ART decreased [48 days (19, 130) vs. 0 days (0, 15.5) post-B+; P < 0.0001]. Among those newly initiating ART, a smaller proportion was alive on ART 6 months after initiation (89.3% vs. 78.8% post-B+; P = 0.0004). Conclusions: Although several improvements in PMTCT program performance were noted with implementation of B+, challenges remain at several critical steps along the cascade requiring innovative solutions to ensure an AIDS-free generation.