Impact of universal ART for pregnant and postpartum women on ART uptake and retention

OBJECTIVE:Universal eligibility for lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (“Option B+”) has been widely adopted, but concerns remain. We tested the hypothesis that the change from CD4-guided ART eligibility (“Option A”), to Option B+, would improve maternal ART uptake and retention. DESIGN:A stepped-wedge evaluation at 12 health facilities in Swaziland. METHODS:Primary outcome was maternal retentionproportion of women attending clinic within 56 days of delivery (antenatal retention) and clinic attendance within 84 days of 6-months postpartum (postnatal retention). Generalized estimating equations examined impact of Option B+ versus Option A. RESULTS:Between 19August2013 and 29August2014, 2347 HIV-positive women, 55% (n = 1296) Option A, 45%, (n = 1051) Option B+ were included. ART initiation was observed in 36% (n = 469) of Option A women versus 94% (n = 983) under Option B+ (p