Prevention of Mother-to-Child Transmission of HIV in Option B+ Era: Uptake and Adherence During Pregnancy in Western Uganda

Schnack, Alexandra; Rempis, Eva; Decker, Sarah; Braun, Vera; Rubaihayo, John; Busingye, Priscilla; Tumwesigye, Nazarius Mbona; Harms, Gundel; Theuring, Stefanie

doi:10.1089/apc.2015.0318

Cited by 48 publications

(64 citation statements)

References 35 publications

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“…A national-wide study done in Malawi, looking at facility-level data, found that nearly 24% (95% CI 22.6-25.3%) of women started on ART while pregnant are lost to follow-up in the first 6 months [7]. These findings were consistent with findings of other observational studies done Sub-Saharan Africa in showing the gaps in retaining women on care once initiated on Option B+ [8,9].…”

Section: Challenges Of Implementing Option B+supporting

confidence: 83%

Civil Society's Contribution to Rolling out of Option B+ in Malawi - A Case of Umunthu Foundation

Odali¹,

Gadama²

2017

ujph

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Option B+ was developed in Malawi in 2010 and adopted in 2011 in response to the impracticality of implementing the World Health Organization (WHO) 2010 guidelines on prevention of mother-to-child transmission (PMTCT) of HIV. The approach was deemed very ambitious in a Malawian setting given the ongoing service delivery challenges. Major challenges included shortage of human resources (qualified health staff), lack of proper infrastructure, stigma associated with taking antiretroviral drugs, shortages of HIV test kits and related accessories. Amidst these challenges, civil society organizations like Umunthu Foundation (UMUFO) partnered with government to better serve mothers living with HIV. UMUFO actively worked with communities to enhance awareness of Option B+ and aide in retaining women in care once initiated on ART. UMUFO has particularly been working with two public health facilities (Limbe and Bangwe Health Centers) in providing HIV testing services, infrastructural needs and hiring health workers. With these services, UMUFO has managed to maintain a significant increase of women tested and started on Option B+ by almost 200% (from 408 in 2014/2015 to 1219 women in 2016/2017) in 3 years. The impact UMUFO has had on rolling out of Option B+ clearly demonstrates the critical role civil society organizations can have in meeting national and global public health targets.

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Section: Challenges Of Implementing Option B+supporting

confidence: 83%

Civil Society's Contribution to Rolling out of Option B+ in Malawi - A Case of Umunthu Foundation

Odali¹,

Gadama²

2017

ujph

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“…All women were drug naïve at enrolment and received the recommended first-line regimen consisting of EFV/3TC/TDF. Socio-demographic and clinical baseline data, as well as information on the antenatal adherence of the study group were published by Schnack et al, 2016[35]. …”

Section: Resultsmentioning

confidence: 99%

Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT

et al. 2017

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BackgroundSince 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm).Methods and findings124 HIV-1 positive pregnant women were enrolled within antenatal care services in Fort Portal, Uganda. Blood samples were collected at the first visit prior starting Option B+ and postpartum at week six, month six, 12 and 18. Viral load was determined by real-time RT-PCR. An RT-PCR covering resistance associated positions in the protease and reverse transcriptase HIV-1 genomic region was performed. PCR-positive samples at 12/18 ppm and respective baseline samples were analysed by next generation sequencing regarding HIV-1 drug resistant variants including low-frequency variants. Furthermore, vertical transmission of HIV-1 was analysed. 49/124 (39.5%) women were included into the DRM analysis. Virological failure, defined as >1000 copies HIV-1 RNA/ml, was observed in three and seven women at 12 and 18 ppm, respectively. Sequences were obtained for three and six of these. In total, DRMs were detected in 3/49 (6.1%) women. Two women displayed dual-class resistance against all recommended first-line regimen drugs. Of 49 mother-infant-pairs no infant was HIV-1 positive at 12 or 18 ppm.ConclusionOur findings suggest that the WHO-recommended Option B+ for PMTCT is effective in a cohort of Ugandan HIV-1 positive pregnant women with regard to the low selection rate of DRMs and vertical transmission. Therefore, these results are encouraging for other countries considering the implementation of lifelong cART for all pregnant HIV-1 positive women.

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“…Given the strategy’s rapid roll out in the region and the challenges of inadequate adherence and early LTFU highlighted in recent quantitative studies [4–5,7–8,10], there is an urgent need to enhance understanding on how to improve ART adherence and retention. Qualitative research is useful for exploring meanings behind quantitative findings [18].…”

Section: Discussionmentioning

confidence: 99%

“…An observational multi-facility cohort study in Malawi had comparable findings of high LTFU (22%) in the first year of implementing Option B+ [5] while a study from one facility in Malawi further clarified that 47% of LTFU women only collected their drugs at the time of initiation but never returned to the same clinic to refill their drugs [6]. Published works from other sub-Saharan African countries also show similar gaps regarding retention in care [7–8]. Some of the factors associated with LTFU under Option B+ included younger age at initiation, [5–6,9] being pregnant (compared to lactating) [6], starting ART on the same day of diagnosis [4,7,9], lack of disclosure [7], missing CD4 cell counts at ART initiation [9], having less than a secondary education [7], and receiving care at high volume facilities [4–5, 9].…”

Section: Introductionmentioning

confidence: 97%

Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study

et al. 2017

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Although several studies have documented challenges related to inadequate adherence to antiretroviral therapy (ART) and high loss to follow-up (LTFU) among Option B+ women, there is limited understanding of why these challenges occur and how to address them. This qualitative study examines women’s experiences with ART adherence and retention in care. Between July and October 2015, in-depth interviews were conducted with 39 pregnant and lactating women who initiated ART at Bwaila Hospital in Lilongwe, Malawi. Study participants included 14 in care and 25 out of care women, according to facility records. Data were analyzed using an inductive, open-coding approach to thematic analysis. Ten of the respondents (7 out of care, 3 in-care) had stopped and re-started treatment before the interview date. One of the most important factors influencing adherence and retention was the strength of women’s support systems. In contrast to women in-care, most out-of-care women lacked emotional and financial support from male partners, received minimal counseling from providers at initiation, lacked designated guardians to assist with medication refills or clinic appointments, and were highly mobile. Mobility led to difficulties in accessing treatment in new settings. The most common reasons women re-started treatment following interruptions were due to providers’ counseling and encouragement and the mother’s desire to be healthy. Improved counseling at initiation, active follow-up counseling, women’s economic empowerment interventions, promotion of peer counseling schemes and meaningful engagement of male partners can help in addressing the identified barriers and promoting sustained retention of Option B+ women.

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Prevention of Mother-to-Child Transmission of HIV in Option B+ Era: Uptake and Adherence During Pregnancy in Western Uganda

Cited by 48 publications

References 35 publications

Civil Society's Contribution to Rolling out of Option B+ in Malawi - A Case of Umunthu Foundation

Civil Society's Contribution to Rolling out of Option B+ in Malawi - A Case of Umunthu Foundation

Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT

Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study

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