Impact of universal antiretroviral therapy for pregnant and postpartum women on antiretroviral therapy uptake and retention

Abrams, Elaine J.; Langwenya, Nontokozo; Gachuhi, Averie B.; Zerbe, Allison; Nuwagaba‐Biribonwoha, Harriet; Mthethwa-Hleta, Simangele; Sahabo, Ruben; Lesosky, Maia; Okello, Velephi; Myer, Landon

doi:10.1097/qad.0000000000002027

Cited by 16 publications

(21 citation statements)

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“…These results along with our findings from earlier periods underscore the urgent need to identify strategies to ensure that women remain in care and on treatment through pregnancy, breastfeeding period and thereafter. [20,21] Perhaps one of the most alarming findings is the large number of patients LTF which is consistent with other studies, including our finding of the highest attrition among pregnant women and younger PLHIV. [8,[22][23][24][25] We also report a large proportion (20%) of patients who did not return after their first visit to the health facilities which few other retention analyses have documented.…”

Section: Discussionsupporting

confidence: 91%

Expansion and scale-up of HIV care and treatment services in four countries over ten years

et al. 2020

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Background Scale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years. Methods We describe PLHIV at enrollment in care and ART initiation in Ethiopia, Kenya, Mozambique and Tanzania from 2005-2014 and report on enrollment location, CD4 count and loss to follow-up (LTF), death, and combined attrition (LTF and death) pre-and post-ART initiation over time. Pre-ART outcomes were estimated using competing risk and post-ART using Kaplan-Meier estimators; LTF defined as no visit within six months pre-ART and 12 months after ART start. Results From 2005-2014, 884,328 PLHIV enrolled in care at 350 health facilities, median age was 32.0 years (interquartile range [IQR] 26.0-42.0), and majority were female (66.5%). The proportion of PLHIV enrolled at primary and rural facilities increased from 12.

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Section: Discussionsupporting

confidence: 91%

Expansion and scale-up of HIV care and treatment services in four countries over ten years

et al. 2020

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“…13,14 The higher ART uptake proportion (98.09 vs. 95.39, P=0.02), and higher proportion of patients who initiate ART within 2 weeks following HIV diagnosis in the T&T group is consistent with other studies, reporting higher ART uptake and earlier ART initiation under the T&T guidelines. 15,16 These constitute very important positive outcomes of the HIV T&T strategy in Cameroon. It was interesting to note that the difference in ART uptake proportion and duration between HIV diagnosis and treatment was not very huge.…”

Section: Discussionsupporting

confidence: 87%

Implications of the human immunodeficiency virus test and treat strategy on antiretroviral treatment uptake and retention outcomes in Cameroon

Awoh

Ekane

Dzudié³

et al. 2019

Int J Community Med Public Health

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Background: Success of the human immunodeficiency virus (HIV) test-and-treat (T&T) strategy requires high antiretroviral (ART) uptake and retention. However, low ART uptake and retention continue to be reported in ART programs. This study assessed ART uptake and retention outcomes of the HIV T&T strategy in three HIV clinics in Cameroon.Methods: A retrospective chart review was done for 423 patients who initiated HIV care within a period of three months prior to the implementation of the HIV T&T strategy, and for another 423 patients who initiated HIV care within a three-month period following the HIV T&T strategy implementation. For each group, sociodemographic, ART uptake and retention data were collected. Chi square and Student T tests were used to test for differences proportions and means between the two groups at p <0.05 and 95% confidence interval.Results: The mean ages (years) in the pre-T&T and the T&T groups were 39.73 and 39.72, and the proportion of female were 65.85% and 65.08% respectively. ART uptake proportion was higher amongst those enrolled under the T&T strategy (98.08% vs 95.39%, p=0.02). A greater proportion of the patients in the T&T group initiated ART within 2 weeks following HIV diagnosis (55.84% vs 48.17%, p=0.03). However, ART retention at 24th month was lower in the T&T group (78.83% vs. 85.79%, p=0.01).Conclusions: The findings suggest that the T&T strategy is associated with higher ART uptake, earlier ART initiation, and lower ART retention. This underscores a need for strategies to improve ART retention under the HIV T&T guidelines.

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“…1 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 2 Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; 3 Desmond Tutu Foundation, Rondebosch, South Africa; 4 Mbarara University of Science and Technology, Mbarara, Uganda; 5 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 6 Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; 7 Harvard Center for Population and Development Studies, Boston, MA, USA; 8 Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda; 9 Makerere-Mbarara Universities Figure 2. Percentage of women with HIV-RNA suppression at 12 months by site and ever-pregnant vs. never-pregnant status Joint AIDS Program (MJAP), Mbarara, Uganda; 10 School of Public Health, Oregon Health and Science University/Portland State University, Portland, OR, USA…”

Section: A U T H O R S ' a F F I L I A T I O N Smentioning

confidence: 99%

“…Data suggested that taking ART to support their child and their own health may promote improved adherence for women [7]. More recent data after institution of Option B+, however, show low rates of viral suppression and high losses to follow-up: for example in eSwatini 53% postpartum retention in care [8], in Tanzania 39% viral suppression at 12 months postpartum [9]. Follow-up studies with tracing of women lost to specific clinic follow-up show that some women are in care elsewhere, though overall postpartum retention in care estimates remain sub-optimal [10].…”

Section: Introductionmentioning

confidence: 99%

Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12‐month cohort study in urban South Africa and rural Uganda

et al. 2020

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Introduction We conducted a cohort study to understand patterns of anti‐retroviral therapy (ART) adherence during pregnancy, postpartum and non‐pregnancy follow‐up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. Methods We collected survey data, continuously monitored ART adherence (Wisepill), HIV‐RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow‐up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non‐pregnancy‐related (neither pregnant nor postpartum). Fractional regression models included demographics and socio‐behavioural factors informed by the Behavioral Model for Vulnerable Populations. We evaluated HIV‐RNA at 12 months by ever‐ versus never‐pregnant status. Results In Uganda, 247 women contributed 676, 900 and 1274 months of pregnancy, postpartum and non‐pregnancy‐related follow‐up. Median ART adherence was consistently ≥90%: pregnancy, 94% (interquartile range [IQR] 78,98); postpartum, 90% (IQR 70,97) and non‐pregnancy, 90% (IQR 80,98). Poorer adherence was associated with younger age (0.98% [95% CI 0.33%, 1.62%] average increase per year of age) and higher CD4 cell count (1.01% [0.08%, 1.94%] average decrease per 50 cells/mm3). HIV‐RNA was suppressed among 91% (N = 135) ever‐pregnant and 86% (N = 85) never‐pregnant women. In South Africa, 190 women contributed 259, 624 and 1247 months of pregnancy, postpartum and non‐pregnancy‐related follow‐up. Median adherence was low during pregnancy, 74% (IQR 31,96); postpartum, 40% (IQR 4,65) and non‐pregnancy, 77% (IQR 47,92). Poorer adherence was associated with postpartum status (22.3% [95%CI 8.6%, 35.4%] average decrease compared to non‐pregnancy‐related follow‐up) and less emotional support (1.4% [0.22%, 2.58%] average increase per unit increase). HIV‐RNA was suppressed among 57% (N = 47) ever‐pregnant and 86% (N = 93) never‐pregnant women. Conclusions Women in rural Uganda maintained high adherence with 91% of ever‐pregnant and 86% of never‐pregnant women suppressing HIV‐RNA at 12 months. Women in urban South Africa struggled with adherence, particularly during postpartum follow‐up with median adherence of 40% and 57% of women with HIV‐RNA suppression at one year, suggesting a crisis for postpartum women with HIV in South Africa. Findings suggest that effective interventions should promote emotional support.

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Impact of universal antiretroviral therapy for pregnant and postpartum women on antiretroviral therapy uptake and retention

Cited by 16 publications

References 15 publications

Expansion and scale-up of HIV care and treatment services in four countries over ten years

Expansion and scale-up of HIV care and treatment services in four countries over ten years

Implications of the human immunodeficiency virus test and treat strategy on antiretroviral treatment uptake and retention outcomes in Cameroon

Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12‐month cohort study in urban South Africa and rural Uganda

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