7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


WELBD01 - Oral Abstract Session

Roll-out of universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (“Option B+”) in Malawi: factors influencing retention in care

Presented by Lyson Nemoni Tenthani (Malawi).

L.N. Tenthani1,2,3, A.D. Haas2, H. Tweya2,4,5, A. Jahn1,3, J.J. van Oosterhout6, F. Chimbwandira1, Z. Chirwa1,3, W. Ng'ambi4, A. Bakali7, S. Phiri4, L. Myer8, F. Valeri2, M. Zwahlen2, G. Wandeler2,9, O. Keiser2, IeDEA Southern Africa

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

Background: Malawi introduced the “Option B+” strategy to prevent mother-to-child transmission of HIV, starting all pregnant and breastfeeding women on lifelong antiretroviral therapy (ART).
Methods: In this cohort study we analysed country-wide facility- and patient-level data from sites with electronic ART register. We explored site- and patient-level factors of loss to follow-up (LTF) by meta-analyses, logistic regression and competing risk survival models.
Results: A total of 21 939 aggregated women data and 28 428 individual women records from sites with electronic medical record system (EMRS) were included. Seventeen per cent of all Option B+ patients were LTF six months after ART initiation. Thirty-seven per cent of the sites performed well with less than 10% of all patients LTF six months after ART initiation. Thirty-three per cent of the sites had LTF >20%. LTF was higher in urban, larger sites with EMRS, in sites operated by the Ministry of Health, and in central hospitals. In larger sites with EMRS, Option B+ patients who started ART during pregnancy were five times more likely to fail to return to the clinics after the initial visit than patients who started with low CD4 cell count and/or in WHO clinical stage 3 or 4 (OR 5·2, 95% CI 4·4-6·2). Option B+ patients who started treatment while breastfeeding, were twice as likely to miss their first follow-up visit (OR 2·3, 95% CI 1·8-2·8) (Figure 1). Pregnant Option B+ patients who started ART on the day they tested HIV+ were less likely to return to clinics than pregnant Option B+ patients who started later (OR 1·7, 95% CI 1·4-2·2).

Figure 1
[Figure 1]

Conclusion: Retention was good at many sites but LTF varied widely. Further investigation should increase our understanding of Option B+ patient LTF early on ART.

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