Assessing Option B+ retention and infant follow-up in Lilongwe,Malawi

Abstract

Malawi launched Option B+, a program for all pregnant or breastfeeding HIV-positive women to begin lifelong combination antiretroviral therapy (cART), in July 2011. This study characterises a portion of the continuum of care within an antenatal setting in Lilongwe. Women testing HIV-positive and having a cART initiation record at Bwaila Antenatal Clinic from July 2013 to January 2014 were included. Using logistic regression models, we analysed relationships between maternal characteristics and return for infant testing. Among 490 HIV-positive women with a cART initiation record, 360 (73%) were retained at three months. Of these, 203 (56%) were adherent. Records of infant testing were located for 204 women (42%). Women who were not retained were less likely to have an early infant diagnosis record (aOR = 0.20; 95% CI: 0.10, 0.41). Among the women retained, there was a non-significant association between maternal adherence and infant testing (OR = 1.35; 95% CI: 0.89, 2.06). Women lost at earlier continuum stages, who are at higher risk for mother-to-child-transmission, were less likely to bring infants for testing. Even with a test-and-treat program, many women did not remain in care or bring their infant for testing. Facilitating strategies to improve these measures remains an important unmet need.

Keywords

Human immunodeficiency virus Africa prevention highly active antiretroviral therapy women

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References

Chimbwandira

Mhango

Makombe

et al.

Impact of an innovative approach to prevent mother-to-child transmission of HIV – Malawi, July 2011-September 2012. MMWR Morb Mortal Wkly Rep 2013; 62: 148–151.

Ahmed

Kim

Abrams

. Risks and benefits of lifelong antiretroviral treatment for pregnant and breastfeeding women: a review of the evidence for the Option B+ approach. Curr Opin HIV AIDS 2013; 8: 474–489.

Mitiku

Arefayne

Mesfin

et al.

Factors associated with loss to follow-up among women in Option B+ PMTCT programme in northeast Ethiopia: a retrospective cohort study. J Int AIDS Soc 2016; 19: 20662–20662.

Schnack

Rempis

Decker

et al.

Prevention of mother-to-child transmission of HIV in option B+ Era: uptake and adherence during pregnancy in Western Uganda. AIDS Patient Care STDS 2016; 30: 110–118.

Llenas-Garcia

Wikman-Jorgensen

Hobbins

et al.

Retention in care of HIV-infected pregnant and lactating women starting ART under Option B+ in rural Mozambique. Trop Med Int Health 2016; 21: 1003–1012.

Dzangare

Takarinda

Harries

et al.

HIV testing uptake and retention in care of HIV-infected pregnant and breastfeeding women initiated on ‘Option B+' in rural Zimbabwe. Trop Med Int Health 2016; 21: 202–209.

Tenthani

Haas

Tweya

et al.

Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (‘Option B+') in Malawi. AIDS 2014; 28: 589–598.

Haas

Tenthani

Msukwa

et al.

Retention in care during the first 3 years of antiretroviral therapy for women in Malawi's option B+ programme: an observational cohort study. Lancet HIV 2016; 3: e175–e182.

Chan

Kanike

Bedell

et al.

Same day HIV diagnosis and antiretroviral therapy initiation affects retention in Option B+ prevention of mother-to-child transmission services at antenatal care in Zomba District, Malawi. J Int AIDS Soc 2016; 19: 20672–20672.

10.

van Lettow

Bedell

Mayuni

et al.

Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+). J Int AIDS Soc 2014; 17: 18994–18994.

11.

Kim

Ahmed

Hosseinipour

et al.

Brief report: impact of option B+ on the Infant PMTCT Cascade in Lilongwe, Malawi. J Acquir Immune Defic Syndr 2015; 70: 99–103.

12.

Martinez Perez

Metcalf

Garone

et al.

HIV testing and retention in care of infants born to HIV- infected women enrolled in ‘Option B+', Thyolo, Malawi. Public Health Action 2014; 4: 102–104.

13.

Kim

Ahmed

Preidis

et al.

Low rates of mother-to-child HIV transmission in a routine programmatic setting in Lilongwe, Malawi. PLoS One 2013; 8: e64979–e64979.

14.

Ahmed

Kim

Dave

et al.

Improved identification and enrolment into care of HIV-exposed and -infected infants and children following a community health worker intervention in Lilongwe, Malawi. J Int AIDS Soc 2015; 18: 19305–19305.

15.

WHO. PMTCT strategic vision 2010-2015: preventing mother-to-child transmission of HIV to reach the UNGASS and millennium development goals, Geneva, Switzerland: World Health Organization Press, 2010.

16.

Douglas

Gadabu

Joukes

et al.

Using touchscreen electronic medical record systems to support and monitor national scale-up of antiretroviral therapy in Malawi. PLoS Med 2010; 7: e1000319–e1000319.

17.

Westreich

Greenland

. The table 2 fallacy: presenting and interpreting confounder and modifier coefficients. Am J Epidemiol 2013; 177: 292–298.

18.

Rollins

Becquet

Orne-Gliemann

et al.

Defining and analyzing retention-in-care among pregnant and breastfeeding HIV-infected women: unpacking the data to interpret and improve PMTCT outcomes. J Acquir Immune Defic Syndr 2014; 67(Suppl 2): S150–S156.

19.

Kim

Ahmed

Hosseinipour

et al.

Implementation and operational research: the impact of option B+ on the antenatal PMTCT cascade in Lilongwe, Malawi. J Acquir Immune Defic Syndr 2015; 68: e77–e83.

20.

UNAIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Joint United Nations Programme on HIV/AIDS (UNAIDS), 2014.

21.

Gross

Bilker

Friedman

Strom

. Effect of adherence to newly initiated antiretroviral therapy on plasma viral load. AIDS 2001; 15: 2109–2117.

22.

Feinstein

Edmonds

Okitolonda

et al.

Implementation and operational research: maternal combination antiretroviral therapy is associated with improved retention of HIV-exposed infants in Kinshasa, Democratic Republic of Congo. J Acquir Immune Defic Syndr 2015; 69: e93–99.

23.

Cook

Ciampa

Sidat

et al.

Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambezia, Mozambique. J Acquir Immune Defic Syndr 2011; 56: e104–e109.

24.

Tejiokem

Faye

Penda

et al.

Feasibility of early infant diagnosis of HIV in resource-limited settings: the ANRS 12140-PEDIACAM study in Cameroon. PLoS One 2011; 6: e21840–e21840.

25.

Cohen

Chen

McCauley

et al.

Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365: 493–505.

26.

Tweya

Feldacker

Estill

et al.

Are they really lost? “true” status and reasons for treatment discontinuation among HIV infected patients on antiretroviral therapy considered lost to follow up in Urban Malawi. PLoS One 2013; 8: e75761–e75761.

27.

Tweya

Gugsa

Hosseinipour

et al.

Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi. Trop Med Int Health 2014; 19: 1360–1366.

28.

Wilkinson

Skordis-Worrall

Ajose

Ford

. Self-transfer and mortality amongst adults lost to follow-up in ART programmes in low- and middle-income countries: systematic review and meta-analysis. Trop Med Int Health 2015; 20: 365–379.

29.

Kalembo

Zgambo

Mulaga

et al.

Association between male partner involvement and the uptake of prevention of mother-to-child transmission of HIV (PMTCT) interventions in Mwanza district, Malawi: a retrospective cohort study. PLoS One 2013; 8: e66517–e66517.

30.

Bocour

Renaud

Udeagu

et al.

HIV partner services are associated with timely linkage to HIV medical care. AIDS 2013; 27: 2961–2963.

31.

Myer

Abrams

Zhang

et al.

Family matters: co-enrollment of family members into care is associated with improved outcomes for HIV-infected women initiating antiretroviral therapy. J Acquir Immune Defic Syndr 2014; 67 (Suppl 4): S243–S249.

32.

MacPherson

Munthali

Ferguson

et al.

Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care. Trop Med Int Health 2015; 20: 1015–1032.

33.

Lall

Lim

Khairuddin

et al.

Review: an urgent need for research on factors impacting adherence to and retention in care among HIV-positive youth and adolescents from key populations. J Int AIDS Soc 2015; 18: 19393–19393.

34.

Dewing

Mathews

Fatti

et al.

Antiretroviral adherence interventions in Southern Africa: implications for using HIV treatments for prevention. Curr HIV/AIDS Rep 2014; 11: 63–71.

35.

Govindasamy

Meghij

Kebede Negussi

et al.

Interventions to improve or facilitate linkage to or retention in pre-ART (HIV) care and initiation of ART in low- and middle-income settings – a systematic review. J Int AIDS Soc 2014; 17: 19032–19032.

36.

Mwapasa

Pro

Chinkhumba

et al.

Mother-infant pair clinic and SMS messaging as innovative strategies for improving access to and retention in eMTCT care and Option B+ in Malawi: a cluster randomized control trial (the PRIME study). J Acquir Immune Defic Syndr 2014; 67 (Suppl 2): S120–S124.

37.

Rosenberg

van Lettow

Tweya

et al.

Improving PMTCT uptake and retention services through novel approaches in peer-based family-supported care in the clinic and community: a 3-arm cluster randomized trial (PURE Malawi). J Acquir Immune Defic Syndr 2014; 67 (Suppl 2): S114–S119.

38.

Phiri

Tweya

van Lettow

et al.

Impact of facility- and community-based peer support models on maternal uptake and retention in Malawi's option B+ HIV prevention of mother-to-child transmission program: a 3-arm cluster randomized controlled trial (PURE Malawi). J Acquir Immune Defic Syndr 2017; 75 (Suppl 2): S140–S1S8.

39.

Aliyu

Blevins

Audet

et al.

Integrated prevention of mother-to-child HIV transmission services, antiretroviral therapy initiation, and maternal and infant retention in care in rural north-central Nigeria: a cluster-randomised controlled trial. Lancet HIV 2016; 3: e202–e211.

40.

Rosenberg

Mtande

Saidi

et al.

Recruiting male partners for couple HIV testing and counselling in Malawi's option B+ programme: an unblinded randomised controlled trial. Lancet HIV 2015; 2: e483–e491.