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. 2015 Apr 15;68(5):e77-83.
doi: 10.1097/QAI.0000000000000517.

Implementation and operational research: the impact of option B+ on the antenatal PMTCT cascade in Lilongwe, Malawi

Maria H Kim  1 , Saeed Ahmed, Mina C Hosseinipour, Thomas P Giordano, Elizabeth Y Chiao, Xiaoying Yu, Chi Nguyen, Frank Chimbwandira, Peter N Kazembe, Elaine J Abrams
Affiliations

Implementation and operational research: the impact of option B+ on the antenatal PMTCT cascade in Lilongwe, Malawi

Maria H Kim et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: In 2011, Malawi implemented Option B+ (B+), lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women. We aimed to describe changes in service uptake and outcomes along the antenatal prevention of mother-to-child transmission (PMTCT) cascade post-B+ implementation.

Design: Pre/post study using routinely collected program data from 2 large Lilongwe-based health centers.

Methods: We compared the testing of HIV-infected pregnant women at antenatal care, enrollment into PMTCT services, receipt of ART, and 6-month ART outcomes pre-B+ (October 2009-March 2011) and post-B+ (October 2011-March 2013).

Results: A total of 13,926 (pre) and 14,532 (post) women presented to antenatal care. Post-B+, a smaller proportion were HIV-tested (99.3% vs. 87.7% post-B+; P < 0.0001). There were 1654 (pre) and 1535 (post) HIV-infected women identified, with a larger proportion already known to be HIV-infected (18.1% vs. 41.2% post-B+; P < 0.0001) and on ART post-B+ (18.7% vs. 30.2% post-B+; P < 0.0001). A significantly greater proportion enrolled into the PMTCT program (68.3% vs. 92.6% post-B+; P < 0.0001) and was retained through delivery post-B+ (51.1% vs. 65% post-B+; P < 0.0001). Among those not on ART at enrollment, there was no change in the proportion newly initiating ART/antiretrovirals (79% vs. 81.9% post-B+; P = 0.11), although median days to initiation of ART decreased [48 days (19, 130) vs. 0 days (0, 15.5) post-B+; P < 0.0001]. Among those newly initiating ART, a smaller proportion was alive on ART 6 months after initiation (89.3% vs. 78.8% post-B+; P = 0.0004).

Conclusions: Although several improvements in PMTCT program performance were noted with implementation of B+, challenges remain at several critical steps along the cascade requiring innovative solutions to ensure an AIDS-free generation.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
HIV testing at antenatal clinic pre-B+ and post-B+ implementation. Graph demonstrating percentage of women who received HIV testing and the total number of HIV-infected women identified pre-B+ and post-B+ (October 2011–March 2013).
FIGURE 2
FIGURE 2
Time from enrollment at ANC to initiation of ART, pre-B+ and post-B+ implementation.
FIGURE 3
FIGURE 3
A, Uptake of services along the antenatal PMTCT cascade, pre-B+ and post-B+ implementation. B, Cumulative maternal outcomes of all women identified at ANC to delivery, pre-B+ (n = 1645) and post-B+ (n = 1535) implementation.
See this image and copyright information in PMC

References

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