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[Preprint]. 2023 Apr 17:2023.04.15.23288495.
doi: 10.1101/2023.04.15.23288495.

Enhanced Peer-Group strategies to support prevention of Mother-to-Child HIV transmission leads to increased retention in care in Uganda: A Randomized controlled trial

Alexander Amone  1 , Grace Gabagaya  1 , Priscilla Wavamunno  1 , Gordon Rukundo  1 , Joyce Namale-Matovu  1 , Samuel S Malamba  2 , Irene Lubega  1 , Jaco Homsy  3 , Rachel King  3 , Clemensia Nakabiito  1 , Zikulah Namukwaya  1 , Mary Glenn Fowler  1   4 , Philippa Musoke  1   5
Affiliations

Enhanced Peer-Group strategies to support prevention of Mother-to-Child HIV transmission leads to increased retention in care in Uganda: A Randomized controlled trial

Alexander Amone et al. medRxiv. .

Update in

Abstract

Introduction: Despite scale up of Option B+, long-term retention of women in HIV care during pregnancy and the postpartum period remains an important challenge. We compared adherence to clinic appointments and antiretroviral therapy (ART) at different follow-up time points between enrolment and 24 months postpartum among pregnant women living with HIV and initiating Option B+ randomized to a peer group support, community-based drug distribution and income-generating intervention called "Friends for Life Circles" (FLCs) versus the standard of care (SOC).

Methods: Between 16 May 2016 and 12 September 2017, 540 ART-naïve pregnant women living with HIV at urban and rural health facilities in Uganda were enrolled in the study. Participants were randomized 1:1 to the FLC intervention or SOC and assessed for adherence to prevention of mother to child HIV transmission (PMTCT) clinic appointments at 6 weeks, 12 and 24 months postpartum, self-reported adherence to ART at 6 weeks, 6 and 24 months postpartum validated by plasma HIV-1 RNA viral load (VL) measured at the same time points, and HIV status and HIV-free survival of infants at 18 months postpartum. We used Log-rank and Chi-Square p-values to test the equality of Kaplan-Meier survival probabilities and hazard rates (HR) for failure to retain in care for any reason by study arm.

Results: There was no significant difference in adherence to PMTCT clinic visits or to ART or in median viral loads between FLC and SOC arms at any follow-up time points. Retention in care through the end of study was high in both arms but significantly higher among participants randomized to FLC (86.7%) compared to SOC (79.3%), p=0.022. The adjusted HR of visit dropout was 2.5 times greater among participants randomized to SOC compared to FLC (aHR=2.498, 95% CI: 1.417 - 4.406, p=0.002). Median VL remained < 400 copies/ml in both arms at 6 weeks, 6 and 24 months postpartum.

Conclusions: Our findings suggest that programmatic interventions that provide group support, community based ART distribution and income-generation activities may contribute to retention in PMTCT care, HIV-free survival of children born to women living with HIV, and to the elimination of mother to child HIV transmission (MTCT).

Keywords: Adherence; HIV; Option B+; Peer support; Retention in care; antiretroviral therapy.

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Conflict of interest statement

Conflict of Interest Statement The authors declare that they have no conflict interests.

Figures

Figure 1 –
Figure 1 –
Trial Profile
Figure 2.
Figure 2.
Kaplan-Meier survival curves for retention in care up to 24 months postpartum.
See this image and copyright information in PMC

References

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