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. 2017 Dec 22;12(12):e0187605.
doi: 10.1371/journal.pone.0187605. eCollection 2017.

Retention in care among HIV-infected pregnant and breastfeeding women on lifelong antiretroviral therapy in Uganda: A retrospective cohort study

Simon Muhumuza  1 , Evelyn Akello  1 , Charity Kyomugisha-Nuwagaba  1 , Rose Baryamutuma  1 , Isaac Sebuliba  1 , Ibrahim M Lutalo  1 , Edgar Kansiime  1 , Linda N Kisaakye  2 , Agnes N Kiragga  3 , Rachel King  4 , William Bazeyo  1 , Christina Lindan  4
Affiliations

Retention in care among HIV-infected pregnant and breastfeeding women on lifelong antiretroviral therapy in Uganda: A retrospective cohort study

Simon Muhumuza et al. PLoS One. .

Abstract

Background: In 2013, Uganda updated its prevention of maternal-to-child transmission of HIV program to Option B+, which requires that all HIV-infected pregnant and breastfeeding women be started on lifelong antiretroviral therapy (ART) regardless of CD4 count. We describe retention in care and factors associated with loss to follow-up (LTFU) among women initiated on Option B+ as part of an evaluation of the effectiveness of the national program.

Methods: We conducted a retrospective cohort analysis of data abstracted from records of 2,169 women enrolled on Option B+ between January and March 2013 from a representative sample of 145 health facilities in all 24 districts of the Central region of Uganda. We defined retention as "being alive and receiving ART at the last clinic visit". We used Kaplan-Meier analysis to estimate retention in care and compared differences between women retained in care and those LTFU using the chi-squared test for dichotomized or categorical variables.

Results: The median follow-up time was 20.2 months (IQR 4.2-22.5). The proportion of women retained in HIV care at 6, 12 and 18 months post-ART initiation was 74.2%, 66.7% and 62.0%, respectively. Retention at 18 months varied significantly by level of health facility and ranged from 70.0% among those seen at hospitals to 56.6% among those seen at lower level health facilities. LTFU was higher among women aged less than 25 years, 59.3% compared to those aged 25 years and above, 40.7% (p = 0.02); among those attending care at lower level facilities, 44.0% compared to those attending care at hospitals, 34.1% (p = 0.01), and among those who were not tested for CD4 cell count at ART initiation, 69.4% compared to those who were tested, 30.9% (p = 0.002).

Conclusion: Retention of women who were initiated on Option B+ during the early phases of roll-out was only moderate, and could undermine the effectiveness of the program. Identifying reasons why women drop out and designing targeted interventions for improved retention should be a priority.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Retention in care over time among women initiated on Option B+ between January and March 2013 in Uganda, stratified by level of health facility.
Fig 2
Fig 2. Proportion of women on Option B+ retained in care at 6, 12 and 18 months, over time, by level of health facility.
See this image and copyright information in PMC

References

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    1. Stover J., et al., The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds. Sex Transm Infect, 2008. 84 Suppl 1: p. i24–i30. - PMC - PubMed

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