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

Autor: Rachel King, Simon Muhumuza, Rose Baryamutuma, Linda Nabitaka Kisaakye, Edgar Kansiime, Agnes Kiragga, William Bazeyo, Ibrahim M. Lutalo, Christina Lindan, Evelyn Akello, Charity Kyomugisha-Nuwagaba, Isaac Sebuliba
Jazyk: angličtina
Rok vydání: 2017
Předmět:
0301 basic medicine
RNA viruses
Maternal Health
Breastfeeding
lcsh:Medicine
HIV Infections
Pathology and Laboratory Medicine
Pediatrics
Chi Square Tests
Geographical Locations
0302 clinical medicine
Mathematical and Statistical Techniques
Immunodeficiency Viruses
Pregnancy
Medicine and Health Sciences
Medicine
Uganda
Public and Occupational Health
030212 general & internal medicine
lcsh:Science
Multidisciplinary
Obstetrics and Gynecology
HIV diagnosis and management
Vaccination and Immunization
Breast Feeding
Medical Microbiology
Viral Pathogens
Viruses
Physical Sciences
Female
Pathogens
Statistics (Mathematics)
Cohort study
Research Article
Adult
medicine.medical_specialty
Anti-HIV Agents
Immunology
HIV prevention
MEDLINE
Antiretroviral Therapy
Research and Analysis Methods
Microbiology
03 medical and health sciences
Antiviral Therapy
Retroviruses
Chi-square test
Humans
Statistical Methods
Microbial Pathogens
Statistical Hypothesis Testing
Retrospective Studies
business.industry
Lentivirus
lcsh:R
Organisms
Biology and Life Sciences
HIV
Retrospective cohort study
medicine.disease
030112 virology
Antiretroviral therapy
Diagnostic medicine
CD4 Lymphocyte Count
Family medicine
People and Places
Africa
Women's Health
lcsh:Q
Preventive Medicine
Neonatology
business
Breast feeding
Mathematics
Zdroj: PLoS ONE, Vol 12, Iss 12, p e0187605 (2017)
PLoS ONE
ISSN: 1932-6203
Popis: 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.
Databáze: OpenAIRE
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