Pregnant women with HIV in rural Nigeria have higher rates of antiretroviral treatment initiation, but similar loss to follow-up as non-pregnant women and men

Abstract

Background: We examined antiretroviral therapy (ART) initiation and retention by sex and pregnancy status in rural Nigeria.

Methods: We studied HIV-infected ART-naïve patients aged ≥15 years entering care from June 2009 to September 2013. We calculated the probability of early ART initiation and cumulative incidence of loss to follow-up (LTFU) during the first year of ART, and examined the association between LTFU and sex/pregnancy using Cox regression.

Results: The cohort included 3813 ART-naïve HIV-infected adults (2594 women [68.0%], 273 [11.8%] of them pregnant). The proportion of pregnant clients initiating ART within 90 days of enrollment (78.0%, 213/273) was higher than among non-pregnant women (54.3%,1261/2321) or men (53.0%, 650/1219), both p<0.001. Pregnant women initiated ART sooner than non-pregnant women and men (median [IQR] days from enrollment to ART initiation for pregnant women=7 days [0-21] vs 14 days [7-49] for non-pregnant women and 14 days [7-42] for men; p<0.001). Cumulative incidence of LTFU during the first year post-ART initiation was high and did not differ by sex and pregnancy status. Persons who were unemployed, bedridden, had higher CD4+ counts, and/or in earlier WHO clinical stages were more likely to be LTFU.

Conclusions: Pregnant women with HIV in rural Nigeria were more likely to initiate ART but were no more likely to be retained in care. Our findings underscore the importance of effective retention strategies across all patient groups, regardless of sex and pregnancy status.

Keywords: Antiretroviral therapy; HIV/AIDS; Loss to follow-up; Nigeria; Retention in care.

Figure 1.

(A) Antiretroviral therapy (ART) initiation during the first 90 days after enrollment by gender and pregnancy status, Vanderbilt University/Friends in Global Health (VU/FGH) Nigeria Program, 2009–2013; (B) ART initiation among ART eligible clients during the first 90 days after enrollment by gender and pregnancy status, VU/FGH Nigeria Program, 2009–2013; (C) Cumulative incidence of loss to follow-up during the first 12 months following ART initiation by gender and pregnancy status at enrollment, VU/FGH Nigeria program (for individuals who were initiated on ART within 90 days of enrollment, n=2124). Solid line: pregnant females; dashed lines: nonpregnant females; dotted lines: males. This figure is available in black and white in print and in colour at International Health online.