Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Infectious Diseases
Abstract
Lifelong antiretroviral therapy for HIV infected pregnant and lactating women (Option B+) has been
rapidly scaled up but there are concerns about poor retention of women initiating treatment. However, facilitybased
data could underestimate retention in the absence of measures to account for self-transfers to other facilities.
We assessed retention-in-care among women on Option B+ in Uganda, using facility data and follow-up to
ascertain transfers to other facilities.
Methods: In a 25-month retrospective cohort analysis of routine program data, women who initiated Option B+
between March 2013 and March 2015 were tracked and interviewed quantitatively and qualitatively (in-depth interviews).
Kaplan Meier survival analysis was used to estimate time to loss-to-follow-up (LTFU) while multivariable Cox proportional
hazards regression was applied to estimate the adjusted predictors of LTFU, based on facility data. Thematic analysis was
done for qualitative data, using MAXQDA 12. Quantitative data were analyzed with STATA® 13.
Results: A total of 518 records were reviewed. The mean (SD) age was 26.4 (5.5) years, 289 women (55.6%) attended
primary school, and 53% (276/518) had not disclosed their HIV status to their partners. At 25 months post-ART initiation,
278 (53.7%) were LTFU based on routine facility data, with mean time to LTFU of 15.6 months. Retention was 60.2 per
1000 months of observation (pmo) (95% CI: 55.9–64.3) at 12, and 46.3/1000pmo (95% CI: 42.0–50.5) at 25 months. Overall,
237 (55%) women were successfully tracked and interviewed and 43/118 (36.4%) of those who were classified as LTFU at
facility level had self-transferred to another facility. The true 25 months post-ART initiation retention after tracking was
71.3% (169/237). Women < 25 years, aHR = 1.71 (95% CI: 1.28–2.30); those with no education, aHR = 5.55 (95% CI: 3.11–
9.92), and those who had not disclosed their status to their partners, aHR = 1.59 (95% CI: 1.16–2.19) were more likely to
be LTFU. Facilitators for Option B+ retention based on qualitative findings were adequate counselling, disclosure, and
the desire to stay alive and raise HIV-free children. Drug side effects, inadequate counselling, stigma, and unsupportive
spouses, were barriers to retention in care.
Conclusions: Retention under Option B+ is suboptimal and is under-estimated at health facility level. There is need to
institute mechanisms for tracking of women across facilities. Retention could be enhanced through strategies to enhance
disclosure to partners, targeting the uneducated, and those <25 years.
Description
Keywords
EMTCT, PMTCT, Retention, LTFU, HIV, Option B+
Citation
Kiwanuka, G., Kiwanuka, N., Muneza, F., Nabirye, J., Oporia, F., Odikro, M. A., ... & Wanyenze, R. K. (2018). Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study. BMC infectious diseases, 18(1), 1-11.https://doi.org/10.1186/s12879-018-3450-9