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 u...
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| creator | Abrams, Elaine J Langwenya, Nontokozo Gachuhi, Averie Zerbe, Allison Nuwagaba-Biribonwoha, Harriet Mthethwa-Hleta, Simangele Sahabo, Ruben Lesosky, Maia Okello, Velephi Myer, Landon |
| description | 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 |
| doi_str_mv | 10.1097/QAD.0000000000002027 |
| format | Article |
| fullrecord | <record><control><sourceid>wolterskluwer</sourceid><recordid>TN_cdi_wolterskluwer_health_10_1097_QAD_0000000000002027</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>10.1097/QAD.0000000000002027</sourcerecordid><originalsourceid>FETCH-wolterskluwer_health_10_1097_QAD_00000000000020273</originalsourceid><addsrcrecordid>eNqlj71uwjAUhS1UJNLCGzDcFwjYCcHJiChVO7ais2XBDX-Obdk35PUbUIeKtWc5y3d09DE2FXwmeCXnn6vXGf-TjGdywBKxkHlaFFI8sYRnyyqtcslH7DnGcw8VvCwT9v3ReL0jcDW09nTFELWB1dcWahfABzxYbQm03YN3kbwO1DbQuQYtOHsHW0_6gnckIKGlk7NjNqy1iTj57RdWvm226_e0c4b6j4tpOwzqiNrQUQmubhqq11CPGvk_pj94n1JQ</addsrcrecordid><sourcetype>Publisher</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Impact of universal ART for pregnant and postpartum women on ART uptake and retention</title><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Journals@Ovid Ovid Autoload</source><creator>Abrams, Elaine J ; Langwenya, Nontokozo ; Gachuhi, Averie ; Zerbe, Allison ; Nuwagaba-Biribonwoha, Harriet ; Mthethwa-Hleta, Simangele ; Sahabo, Ruben ; Lesosky, Maia ; Okello, Velephi ; Myer, Landon</creator><creatorcontrib>Abrams, Elaine J ; Langwenya, Nontokozo ; Gachuhi, Averie ; Zerbe, Allison ; Nuwagaba-Biribonwoha, Harriet ; Mthethwa-Hleta, Simangele ; Sahabo, Ruben ; Lesosky, Maia ; Okello, Velephi ; Myer, Landon</creatorcontrib><description>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 < 0.001). Overall 39% (n = 912) were retained from first ANC visit through 6-months postpartum. Retention was higher under Option B+ (53%, n = 559) versus Option A (24%, n = 353) with variation by site and study month. Adjusting for age, gestational age, previous HIV diagnosis and CD4, Option B+ women were significantly more likely to be retained antenatally (aRR 1.32; 95% CI 1.18–1.49; p < 0.001) and postnatally (aRR 2.11; 95% CI 1.79–2.49) compared with Option A. Restricted to women initiating ART, retention was lower under Option B+ (57%, n = 558) versus Option A (66%, n = 309), (aRR, 0.82; 95% CI, 0.70–0.95; p < 0.0001).
CONCLUSIONS:Compared with CD4-guided ART eligibility, universal ART resulted in substantial increases in pregnant women initiating ART and retained in care through 6-months postpartum.</description><identifier>ISSN: 0269-9370</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0000000000002027</identifier><language>eng</language><publisher>Copyright Wolters Kluwer Health, Inc</publisher><ispartof>AIDS (London), 2018-10</ispartof><rights>Copyright © 2018 Wolters Kluwer Health, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids></links><search><creatorcontrib>Abrams, Elaine J</creatorcontrib><creatorcontrib>Langwenya, Nontokozo</creatorcontrib><creatorcontrib>Gachuhi, Averie</creatorcontrib><creatorcontrib>Zerbe, Allison</creatorcontrib><creatorcontrib>Nuwagaba-Biribonwoha, Harriet</creatorcontrib><creatorcontrib>Mthethwa-Hleta, Simangele</creatorcontrib><creatorcontrib>Sahabo, Ruben</creatorcontrib><creatorcontrib>Lesosky, Maia</creatorcontrib><creatorcontrib>Okello, Velephi</creatorcontrib><creatorcontrib>Myer, Landon</creatorcontrib><title>Impact of universal ART for pregnant and postpartum women on ART uptake and retention</title><title>AIDS (London)</title><description>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 < 0.001). Overall 39% (n = 912) were retained from first ANC visit through 6-months postpartum. Retention was higher under Option B+ (53%, n = 559) versus Option A (24%, n = 353) with variation by site and study month. Adjusting for age, gestational age, previous HIV diagnosis and CD4, Option B+ women were significantly more likely to be retained antenatally (aRR 1.32; 95% CI 1.18–1.49; p < 0.001) and postnatally (aRR 2.11; 95% CI 1.79–2.49) compared with Option A. Restricted to women initiating ART, retention was lower under Option B+ (57%, n = 558) versus Option A (66%, n = 309), (aRR, 0.82; 95% CI, 0.70–0.95; p < 0.0001).
CONCLUSIONS:Compared with CD4-guided ART eligibility, universal ART resulted in substantial increases in pregnant women initiating ART and retained in care through 6-months postpartum.</description><issn>0269-9370</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNqlj71uwjAUhS1UJNLCGzDcFwjYCcHJiChVO7ais2XBDX-Obdk35PUbUIeKtWc5y3d09DE2FXwmeCXnn6vXGf-TjGdywBKxkHlaFFI8sYRnyyqtcslH7DnGcw8VvCwT9v3ReL0jcDW09nTFELWB1dcWahfABzxYbQm03YN3kbwO1DbQuQYtOHsHW0_6gnckIKGlk7NjNqy1iTj57RdWvm226_e0c4b6j4tpOwzqiNrQUQmubhqq11CPGvk_pj94n1JQ</recordid><startdate>20181004</startdate><enddate>20181004</enddate><creator>Abrams, Elaine J</creator><creator>Langwenya, Nontokozo</creator><creator>Gachuhi, Averie</creator><creator>Zerbe, Allison</creator><creator>Nuwagaba-Biribonwoha, Harriet</creator><creator>Mthethwa-Hleta, Simangele</creator><creator>Sahabo, Ruben</creator><creator>Lesosky, Maia</creator><creator>Okello, Velephi</creator><creator>Myer, Landon</creator><general>Copyright Wolters Kluwer Health, Inc</general><scope/></search><sort><creationdate>20181004</creationdate><title>Impact of universal ART for pregnant and postpartum women on ART uptake and retention</title><author>Abrams, Elaine J ; Langwenya, Nontokozo ; Gachuhi, Averie ; Zerbe, Allison ; Nuwagaba-Biribonwoha, Harriet ; Mthethwa-Hleta, Simangele ; Sahabo, Ruben ; Lesosky, Maia ; Okello, Velephi ; Myer, Landon</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-wolterskluwer_health_10_1097_QAD_00000000000020273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abrams, Elaine J</creatorcontrib><creatorcontrib>Langwenya, Nontokozo</creatorcontrib><creatorcontrib>Gachuhi, Averie</creatorcontrib><creatorcontrib>Zerbe, Allison</creatorcontrib><creatorcontrib>Nuwagaba-Biribonwoha, Harriet</creatorcontrib><creatorcontrib>Mthethwa-Hleta, Simangele</creatorcontrib><creatorcontrib>Sahabo, Ruben</creatorcontrib><creatorcontrib>Lesosky, Maia</creatorcontrib><creatorcontrib>Okello, Velephi</creatorcontrib><creatorcontrib>Myer, Landon</creatorcontrib><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abrams, Elaine J</au><au>Langwenya, Nontokozo</au><au>Gachuhi, Averie</au><au>Zerbe, Allison</au><au>Nuwagaba-Biribonwoha, Harriet</au><au>Mthethwa-Hleta, Simangele</au><au>Sahabo, Ruben</au><au>Lesosky, Maia</au><au>Okello, Velephi</au><au>Myer, Landon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of universal ART for pregnant and postpartum women on ART uptake and retention</atitle><jtitle>AIDS (London)</jtitle><date>2018-10-04</date><risdate>2018</risdate><issn>0269-9370</issn><eissn>1473-5571</eissn><abstract>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 < 0.001). Overall 39% (n = 912) were retained from first ANC visit through 6-months postpartum. Retention was higher under Option B+ (53%, n = 559) versus Option A (24%, n = 353) with variation by site and study month. Adjusting for age, gestational age, previous HIV diagnosis and CD4, Option B+ women were significantly more likely to be retained antenatally (aRR 1.32; 95% CI 1.18–1.49; p < 0.001) and postnatally (aRR 2.11; 95% CI 1.79–2.49) compared with Option A. Restricted to women initiating ART, retention was lower under Option B+ (57%, n = 558) versus Option A (66%, n = 309), (aRR, 0.82; 95% CI, 0.70–0.95; p < 0.0001).
CONCLUSIONS:Compared with CD4-guided ART eligibility, universal ART resulted in substantial increases in pregnant women initiating ART and retained in care through 6-months postpartum.</abstract><pub>Copyright Wolters Kluwer Health, Inc</pub><doi>10.1097/QAD.0000000000002027</doi></addata></record> |
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| title | Impact of universal ART for pregnant and postpartum women on ART uptake and retention |
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