ART attrition and risk factors among Option B+ patients in Haiti: A retrospective cohort study

Abstract

ObjectivesIn October 2012, the Haitian Ministry of Health endorsed the “Option B+” strategy to eliminate mother-to-child transmission of HIV and achieve HIV epidemic control. The objective of this paper is to assess and identify risk factors for attrition from the national ART program among Option B+ patients in the 12 months after ART initiation.DesignThis retrospective cohort study included patients newly initiating ART from October 2012-August 2013 at 68 ART sites covering 45% of all newly enrolled ART patients in all regions of Haiti.MethodsWith data from electronic medical records, we carried out descriptive analysis of sociodemographic, clinical, and pregnancy-related correlates of ART attrition, and used a modified Poisson regression approach to estimate relative risks in a multivariable model.ResultsThere were 2,166 Option B+ patients who initiated ART, of whom 1,023 were not retained by 12 months (47.2%). One quarter (25.3%) dropped out within 3 months of ART initiation. Protective factors included older age, more advanced HIV disease progression, and any adherence counseling prior to ART initiation, while risk factors included starting ART late in gestation, starting ART within 7 days of HIV testing, and using an atypical ART regimen.DiscussionOur study demonstrates early ART attrition among Option B+ patients and contributes evidence on the characteristics of women who are most at risk of attrition in Haiti. Our findings highlight the importance of targeted strategies to support retention among Option B+ patients.

Pregnant women’s retention and associated health facility characteristics in the prevention of mother-to-child HIV transmission in Indonesia: cross-sectional study

“…As reported by a study in Uganda, 26 demographic factors such as younger age and lower education of the women contributed to higher LTFU in PMTCT programmes. 27 Furthermore, the use of routine PMTCT data collected by the MoH, which are not designed for research purposes, somewhat limited our options for analysis as several relevant, contextual healthcare-related variables, such as the ratio between women and health workers, strategies implemented by the health facilities to ensure women's retention, external support received by the health facilities to implement the programme, or technical aspects of PMTCT monitoring, were absent.…”

Local and national stakeholders’ perceptions towards implementing and scaling up HIV self-testing and secondary distribution of HIV self-testing by Option B+ patients as an assisted partner service strategy to reach men in Haiti

“…In 2012, the MSPP expanded access to lifelong HIV antiretroviral therapy (ART) for all pregnant and postpartum women, regardless of level of HIV disease progression, via the Option B+ program and in July 2016 the MSPP extended universal treatment for HIV to all persons living with HIV (PLWH). Retention on ART at 12 months after starting treatment is estimated at 73.1%, short of the level required for viral suppression [6], and there is evidence that women starting ART during the perinatal period are at elevated risk of loss-to-follow up [3,7]. Lack of couples HIV testing and disclosure of HIV status between partners is a frequently cited reason for the high rates of ART attrition among Option B+ clients [8].…”

Fifteen years of HIV and syphilis outcomes among a prevention of mother‐to‐child transmission program in Haiti: from monotherapy to Option B+

“…At 3 months after infant enrolment in PMTCT at GHESKIO, only 15% of infants were lost vs. 34% in a meta-analysis of 14 studies from resource-poor countries [32]. Attrition (26%) was greatest around the time of delivery, as has been reported as a challenge in other studies [34][35][36]. A PMTCT clinic in Les Cayes, Haiti reported 20% of women becoming lost by time of delivery [25,35].…”