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New Publications in HIV

Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+') in Malawi.

Tenthani L et al. AIDS 2014;28:589–98.

• This study investigated the levels and determinants of loss to follow-up with universal lifelong ART for pregnant and breastfeeding women ('Option B+') in Malawi. • Of 21,939 women who started ART under Option B+, 17% appeared to be lost to follow-up 6 months after initiation of ART. Most losses occurred within the first 3 months. • Patients who started ART during pregnancy were five times more likely to never return after their initial clinic visit [OR: 5.0; 95% CI: 4.2–6.1] than women who started ART at WHO stage 3/4 or with a CD4 cell count ≤350 cells/μL. • Patients who started ART while breastfeeding were twice as likely to miss their first follow-up visit (OR: 2.2; 95% CI: 1.8–2.8). • Loss to follow-up varied considerably between facilities, ranging from 0% to 58%. • Conclusions: The effectiveness of Option B+ will be improved by reducing loss to follow-up. Tailored interventions, e.g. community or family-based models of care, could also help.

Link Link to abstract Full article requires payment

Editorial Option B+ for prevention of mother-to-child transmission of HIV in resource-constrained settings: great promise but some early caution.

Shaffer N et al. AIDS 2014;28:599–601.

• This study investigated the levels and determinants of loss to follow-up with universal lifelong ART for pregnant and breastfeeding women ('Option B+') in Malawi. • Of 21,939 women who started ART under Option B+, 17% appeared to be lost to follow-up 6 months after initiation of ART. Most losses occurred within the first 3 months. • Patients who started ART during pregnancy were five times more likely to never return after their initial clinic visit [OR: 5.0; 95% CI: 4.2–6.1] than women who started ART at WHO stage 3/4 or with a CD4 cell count ≤350 cells/μL. • Patients who started ART while breastfeeding were twice as likely to miss their first follow-up visit (OR: 2.2; 95% CI: 1.8–2.8). • Loss to follow-up varied considerably between facilities, ranging from 0% to 58%. • Conclusions: The effectiveness of Option B+ will be improved by reducing loss to follow-up. Tailored interventions, e.g. community or family-based models of care, could also help.

Link Link to abstract Full article requires payment

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