Programmatic Retention in Prevention of Mother-to-Child Transmission (PMTCT) Programs: Estimated Rates and Cofactors Using Different Nonretention Measures.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 02 2023
01 02 2023
Historique:
received:
05
04
2022
accepted:
13
09
2022
pmc-release:
01
02
2024
pubmed:
11
10
2022
medline:
13
1
2023
entrez:
10
10
2022
Statut:
ppublish
Résumé
Prevention of mother-to-child transmission programs serve women continuing and initiating antiretroviral therapy (ART) in pregnancy, and follow-up schedules align to delivery rather than ART initiation, making conventional HIV retention measures (assessed from ART initiation) challenging to apply. We evaluated 3 measures of peripartum nonretention in Kenyan women living with HIV from pregnancy to 2 years postpartum. This longitudinal analysis used programmatic data from the Mobile WAChX trial (NCT02400671). Outcomes included loss to follow-up (LTFU) (no visit for ≥6 months), incomplete visit coverage (<80% of 3-month intervals with a visit), and late visits (>2 weeks after scheduled date). Predictors of nonretention were determined using Cox proportional hazards, log-binomial, and generalized estimating equation models. Among 813 women enrolled at a median of 24 weeks gestation, incidence of LTFU was 13.6/100 person-years; cumulative incidence of LTFU by 6, 12, and 24 months postpartum was 16.7%, 20.9%, and 22.5%, respectively. Overall, 35.5% of women had incomplete visit coverage. Among 794 women with 12,437 scheduled visits, a median of 11.1% of visits per woman were late (interquartile range 4.3%-23.5%). Younger age, unsuppressed viral load, unemployment, ART initiation in pregnancy, and nondisclosure were associated with nonretention by all measures. Partner involvement was associated with better visit coverage and timely attendance. Women who became LTFU had higher frequency of previous late visits (16.7% vs. 7.7%, P < 0.0001). Late visit attendance may be a sentinel indicator of LTFU. Identified cofactors of prevention of mother-to-child transmission programmatic retention may differ depending on retention measure assessed, highlighting the need for standardized measures.
Sections du résumé
BACKGROUND
Prevention of mother-to-child transmission programs serve women continuing and initiating antiretroviral therapy (ART) in pregnancy, and follow-up schedules align to delivery rather than ART initiation, making conventional HIV retention measures (assessed from ART initiation) challenging to apply. We evaluated 3 measures of peripartum nonretention in Kenyan women living with HIV from pregnancy to 2 years postpartum.
METHODS
This longitudinal analysis used programmatic data from the Mobile WAChX trial (NCT02400671). Outcomes included loss to follow-up (LTFU) (no visit for ≥6 months), incomplete visit coverage (<80% of 3-month intervals with a visit), and late visits (>2 weeks after scheduled date). Predictors of nonretention were determined using Cox proportional hazards, log-binomial, and generalized estimating equation models.
RESULTS
Among 813 women enrolled at a median of 24 weeks gestation, incidence of LTFU was 13.6/100 person-years; cumulative incidence of LTFU by 6, 12, and 24 months postpartum was 16.7%, 20.9%, and 22.5%, respectively. Overall, 35.5% of women had incomplete visit coverage. Among 794 women with 12,437 scheduled visits, a median of 11.1% of visits per woman were late (interquartile range 4.3%-23.5%). Younger age, unsuppressed viral load, unemployment, ART initiation in pregnancy, and nondisclosure were associated with nonretention by all measures. Partner involvement was associated with better visit coverage and timely attendance. Women who became LTFU had higher frequency of previous late visits (16.7% vs. 7.7%, P < 0.0001).
CONCLUSIONS
Late visit attendance may be a sentinel indicator of LTFU. Identified cofactors of prevention of mother-to-child transmission programmatic retention may differ depending on retention measure assessed, highlighting the need for standardized measures.
Identifiants
pubmed: 36215980
doi: 10.1097/QAI.0000000000003117
pii: 00126334-202302010-00002
pmc: PMC9839514
mid: NIHMS1840986
doi:
Types de publication
Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
106-114Subventions
Organisme : NICHD NIH HHS
ID : R01 HD080460
Pays : United States
Organisme : NIAID NIH HHS
ID : K01 AI116298
Pays : United States
Organisme : NICHD NIH HHS
ID : K12 HD001264
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027757
Pays : United States
Organisme : NIMH NIH HHS
ID : K18 MH122978
Pays : United States
Organisme : NICHD NIH HHS
ID : K24 HD054314
Pays : United States
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
World Health Organization. Use of Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants; Geneva, Switzerland 2012. Published online.
World Health Organization. Guideline on when to Start Antiretroviral Therapy and on Preexposure Prophylaxis for HIV; Geneva, Switzerland 2015. Published online.
McNairy ML, Teasdale CA, El-Sadr WM, et al. Mother and child both matter: reconceptualizing the prevention of mother-to-child transmission care continuum. Curr Opin HIV AIDS. 2015;10:403–410.
hIarlaithe MO, Grede N, de Pee S, Bloem M. Economic and social factors are some of the most common barriers preventing women from accessing maternal and newborn child health (MNCH) and prevention of mother-to-child transmission (PMTCT) services: a literature review. AIDS Behav. 2014;18:S516–S530.
Vrazo AC, Firth J, Amzel A, et al. Interventions to significantly improve service uptake and retention of HIV-positive pregnant women and HIV-exposed infants along the prevention of mother-to-child transmission continuum of care: systematic review. Trop Med Int Health. 2018;23:136–148.
Mitiku I, Arefayne M, Mesfin Y, Gizaw M. Factors associated with loss to follow-up among women in Option B+ PMTCT programme in northeast Ethiopia: a retrospective cohort study. J Int AIDS Soc. 2016;19:20662.
Dzangare J, Takarinda KC, Harries AD, et al. HIV testing uptake and retention in care of HIV-infected pregnant and breastfeeding women initiated on ‘Option B+’ in rural Zimbabwe. Trop Med Int Health. 2016;21:202–209.
Reece R, Norman B, Kwara A, et al. Retention in care of HIV-positive postpartum females in Kumasi, Ghana. J Int Assoc Provid AIDS Care. 2016;15:406–411.
E Rawizza H, A Chang C, Chaplin B, et al. Loss to follow-up within the prevention of mother-to-child transmission care cascade in a large ART program in Nigeria. Curr HIV Res. 2015;13:201–209.
World Health Organization. Consolidated Strategic Information Guidelines for HIV in the Health Sector; Geneva. 2015. Published Online.
Inter-Agency Task Teams. B+ monitoring & evaluation framework dissemination and country consultation: adapting monitoring & evaluation systems for cohort and enhanced monitoring as well as outcome and impact evaluations/assessments. Available at: https://www.childrenandaids.org/sites/default/files/2017-04/IATT_B%2BMonitoring-and-Evaluation-Framework_2016.pdf .
Rollins NC, Becquet R, Orne-Gliemann J, et al. Defining and analyzing retention-in-care among pregnant and breastfeeding HIV-infected women: unpacking the data to interpret and improve PMTCT outcomes. J Acquir Immune Defic Syndr. 2014;67(suppl 2):S150–S156.
Sibanda EL, Weller IVD, Hakim JG, Cowan FM. The magnitude of loss to follow-up of HIV-exposed infants along the prevention of mother-to-child HIV transmission continuum of care: a systematic review and meta-analysis. AIDS. 2013;27:2787–2797.
Geng EH, Nash D, Kambugu A, et al. Retention in care among HIV-infected patients in resource-limited settings: emerging insights and new directions. Curr HIV/AIDS Rep. 2010;7:234–244.
Chi BH, Yiannoutsos CT, Westfall AO, et al. Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America. PLoS Med. 2011;8:e1001111.
Yotebieng M, Thirumurthy H, Moracco KE, et al. Conditional cash transfers to increase retention in PMTCT care, antiretroviral adherence, and postpartum virological suppression: a randomized controlled trial. J Acquir Immune Defic Syndr. 2016;72:S124–S129.
Tenthani L, Haas AD, Tweya H, et al. Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women (‘Option B+’) in Malawi. AIDS. 2014;28:589–598.
Woelk GB, Ndatimana D, Behan S, et al. Retention of mothers and infants in the prevention of mother-to-child transmission of HIV programme is associated with individual and facility-level factors in Rwanda. J Int AIDS Soc. 2016;19:20837.
Hoffman RM, Phiri K, Parent J, et al. Factors associated with retention in Option B+ in Malawi: a case control study. J Int AIDS Soc. 2017;20:21464.
Miller K, Muyindike W, Matthews LT, et al. Program implementation of option B+ at a president's emergency plan for AIDS relief-supported HIV clinic improves clinical indicators but not retention in care in Mbarara, Uganda. AIDS Patient Care STDS. 2017;31:335–341.
Wesevich A, Mtande T, Saidi F, et al. Role of male partner involvement in ART retention and adherence in Malawi's Option B+ program. AIDS Care. 2017;29:1417–1425.
Etoori D, Kerschberger B, Staderini N, et al. Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland. BMC Public Health. 2018;18:374.
Gill MM, Ditekemena J, Loando A, et al. Addressing early retention in antenatal care among HIV-positive women through a simple intervention in kinshasa, DRC: the elombe “champion” standard operating procedure. AIDS Behav. 2018;22:860–866.
Kiwanuka G, Kiwanuka N, Muneza F, et al. Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study. BMC Infect Dis. 2018;18:533.
Alamdo AG, King EJ. Retention in care and health outcomes of HIV-exposed infants in a prevention of mother-to-child transmission of HIV (PMTCT) cohort in Addis Ababa, Ethiopia. HIV/AIDS (Auckl). 2021;13:171–179.
Font H, Rollins N, Essajee S, et al. Retention-in-care in the PMTCT cascade: definitions matter! Analyses from the INSPIRE projects in Malawi, Nigeria and Zimbabwe. J Int AIDS Soc. 2020;23:e25609.
Drake AL, Unger JA, Ronen K, et al. Evaluation of mHealth strategies to optimize adherence and efficacy of Option B+ prevention of mother-to-child HIV transmission: rationale, design and methods of a 3-armed randomized controlled trial. Contemp Clin Trials. 2017;57:44–50.
Kinuthia J, Ronen K, Unger IDJA, et al. SMS messaging to improve retention and viral suppression in prevention of mother-to-child HIV transmission (PMTCT) programs in Kenya: a 3-arm randomized clinical trial. PLoS Med. 2021;18:e1003650.
Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32:705–714.
Rao D, Feldman BJ, Fredericksen RJ, et al. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012;16:711–716.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613.
Soeken KL, McFarlane J, Parker B, Lominack MC. The abuse assessment screen: a clinical instrument to measure frequency, severity, and perpetrator of abuse against women. In: Empowering Survivors Of Abuse: Health Care For Battered Women And Their Children. Sage Series on Violence against Women. Thousand Oaks, CA: Sage Publications, Inc; 1998:195–203.
Swindale A, Bilinsky P. Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues. J Nutr. 2006;136:1449S–1452S.
Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25:462–473.
Williams F, Boren SA. The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Inform Prim Care. 2008;16:139–145.
McDougal L, Moteetee MM, Mohai F, et al. Lesotho's minimum PMTCT package: lessons learned for combating vertical HIV transmission using co-packaged medicines. J Int AIDS Soc. 2012;15:17326.
Sabharwal CJ, Braunstein SL, Robbins RS, Shepard CW. Optimizing the use of surveillance data for monitoring the care status of persons recently diagnosed with HIV in NYC. J Acquir Immune Defic Syndr. 2014;65:571–578.
Haas AD, van Oosterhout JJ, Tenthani L, et al. HIV transmission and retention in care among HIV-exposed children enrolled in Malawi's prevention of mother-to-child transmission programme. J Int AIDS Soc. 2017;20:21947.
Gumede-Moyo S, Filteau S, Munthali T, et al. Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: a systematic literature review. Medicine (Baltimore). 2017;96:e8055.
Wettstein C, Mugglin C, Egger M, et al. Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis. AIDS. 2012;26:2361–2373.
Marcos Y, Phelps BR, Bachman G. Community strategies that improve care and retention along the prevention of mother-to-child transmission of HIV cascade: a review. J Int AIDS Soc. 2012;15:17394.
Kaplan SR, Oosthuizen C, Stinson K, et al. Contemporary disengagement from antiretroviral therapy in Khayelitsha, South Africa: a cohort study. PLoS Med. 2017;14:e1002407.
Sibanda EL, Cowan FM. Good news for retention of women on option B+ in Malawi. Lancet HIV. 2016;3:e151–e152.
Nachega JB, Uthman OA, Anderson J, et al. Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS. 2012;26:2039–2052.
Phillips T, Thebus E, Bekker LG, et al. Disengagement of HIV-positive pregnant and postpartum women from antiretroviral therapy services: a cohort study. J Int AIDS Soc. 2014;17:19242.
Paredes R, Marconi VC, Lockman S, et al. Impact of antiretroviral drugs in pregnant women and their children in africa: HIV resistance and treatment outcomes. J Infect Dis. 2013;207:S93–S100.
Atanga PN, Ndetan HT, Achidi EA, et al. Retention in care and reasons for discontinuation of lifelong antiretroviral therapy in a cohort of Cameroonian pregnant and breastfeeding HIV-positive women initiating “Option B+” in the South West Region. Trop Med Int Health. 2017;22:161–170.
Cichowitz C, Mazuguni F, Minja L, et al. Vulnerable at each step in the PMTCT care cascade: high loss to follow up during pregnancy and the postpartum period in Tanzania. AIDS Behav. 2019;23:1824–1832.
Ahoua L, Tiendrebeogo T, Arikawa S, et al. PMTCT care cascade and factors associated with attrition in the first four years after Option B+ implementation in Mozambique. Trop Med Int Health. 2020;25:222–235.
Nassali M, Nakanjako D, Kyabayinze D, et al. Access to HIV/AIDS care for mothers and children in sub-Saharan Africa: adherence to the postnatal PMTCT program. AIDS Care. 2009;21:1124–1131.
Busza J, Walker D, Hairston A, et al. Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review. J Int AIDS Soc. 2012;15:17373.
Ferguson L, Grant AD, Watson-Jones D, et al. Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review. Trop Med Int Health. 2012;17:564–580.
Aluisio A, Richardson BA, Bosire R, et al. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr. 2011;56:76–82.
Kalembo FW, Zgambo M, Mulaga AN, et al. Association between male partner involvement and the uptake of prevention of mother-to-child transmission of HIV (PMTCT) interventions in Mwanza district, Malawi: a retrospective cohort study. PLoS One. 2013;8:e66517.
Tweya H, Gugsa S, Hosseinipour M, et al. Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi. Trop Med Int Health. 2014;19:1360–1366.
Ministry of Health. Kenya AIDS Response Progress Report 2016. Available at: https://nacc.or.ke/wp-content/uploads/2016/11/Kenya-AIDS-Progress-Report_web.pdf .