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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+') in Malawi
AIDS, Volume 28, No. 4, Year 2014
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Description
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 (nS=S21S939), as well as individual-level data on patients who started ART at 19 large facilities (nS=S11S534). RESULTS:: Of the women who started ART under Option B+ (nS=S21S939), 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 350Scells/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. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Tenthani, Lyson
Malawi, Lilongwe
Ministry of Health Malawai
Switzerland, Bern
University of Bern
United States, Seattle
University of Washington
Haas, Andreas D.
Switzerland, Bern
University of Bern
Tweya, Hannock M.
Switzerland, Bern
University of Bern
Malawi, Lilongwe
Lighthouse Trust
France, Paris
International Union Against Tuberculosis and Lung Disease
Jahn, Andreas
Malawi, Lilongwe
Ministry of Health Malawai
United States, Seattle
University of Washington
van Oosterhout, Joep J.G.
Canada, Toronto
Dignitas International
Chimbwandira, Frank M.
Malawi, Lilongwe
Ministry of Health Malawai
Chirwa, Zengani
Switzerland, Bern
University of Bern
United States, Seattle
University of Washington
Ng'Ambi, Wingston Felix
Malawi, Lilongwe
Lighthouse Trust
Bakali, Alan
Malawi
Baobab Trust
Phiri, Sam John Peter
Malawi, Lilongwe
Lighthouse Trust
Myer, Landon
South Africa, Cape Town
University of Cape Town
Valeri, Fabio
Switzerland, Bern
University of Bern
Zwahlen, Marcel
Switzerland, Bern
University of Bern
Wandeler, Gilles
Switzerland, Bern
University of Bern
Switzerland, Bern
University Hospital Bern
Senegal, Dakar
Université Cheikh Anta Diop de Dakar
Keiser, Olivia
Switzerland, Bern
University of Bern
Statistics
Citations: 15
Authors: 15
Affiliations: 10
Identifiers
Doi:
10.1097/QAD.0000000000000143
e-ISSN:
14735571
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Case-Control Study
Study Locations
Malawi
Participants Gender
Female