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Retention of HIV+ pregnant and breastfeeding women on universal antiretroviral therapy (Option B+) in Malawi

Retention of HIV+ pregnant and breastfeeding women on universal antiretroviral therapy (Option B+) in Malawi.

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Retention of HIV+ pregnant and breastfeeding women on universal antiretroviral therapy (Option B+) in Malawi

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  1. Retention of HIV+ pregnant and breastfeeding women on universal antiretroviral therapy (Option B+) in Malawi Lyson Tenthani* & Andreas Haas*, Hannock Tweya, Andreas Jahn, Joep J van Oosterhout, Frank Chimbwandira, ZenganiChirwa, Wingston Ng’ambi, Alan Bakali, Sam Phiri, Landon Myer, Fabio Valeri, Marcel Zwahlen, Gilles Wandeler*, Olivia Keiser*for the Ministry of Health in Malawi and IeDEA Southern Africa * equal contribution

  2. Background Malawi pioneered “Option B+” to prevent mother-to-child transmission (PMTCT) of HIV. (Potential) benefits • Higher PMTCT coverage • Improved PMTCT • Reduced maternal morbidity and mortality • Avoiding repeated short-course antiretroviral exposures • Reduced transmission to serodiscordantpartners Concerns • Acceptability of ART to prevent mother-to-child transmission • Retention and adherence among asymptomatically HIV infected women

  3. Methods Facility-leveldata from on 21939 Option B+ patients from 540 sites Patient-leveldata from 19 sites with EMRS Kaplan-Meier curves for time from HIV testing to ART start Descriptive analysisof 6 months retention rates Logistic regression & competing risk regression for loss to follow-up Descriptive analysis of the proportion of patients loss to follow-up per site Meta-analysis& meta-regression for site level predictors of loss to follow-up Meta-regression for site-level predictors of loss to follow-up

  4. Loss to follow-up among Option B+ patients 6 months after ART start

  5. Site-level predictors for loss to follow-up

  6. Loss to follow-up among Option B+ patients 6 months after ART start Non Electronic Electronic

  7. Cumulative incidence of loss to follow-up

  8. No follow-up and loss to follow-up

  9. Percentage of Option B+ pregnant women with no follow-up visit

  10. Time from HIV testing to ART initiation

  11. Conclusion • Compared to ART patients in an advanced stage of the disease Option B+ patients are at increased risk of loss to follow-up. • Pregnant Option B+ patients are at particularly high risk to get lost. • Most Option B+ patients who were lost started at the day of HIV testing and never came back. • ART preparation at first visit is crucial. • Barriers to retention in care need to be fully understood. • Many sites with a low rate of LTF demonstrate that a good level of retention in care can be achieved.

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