Option B+ for prevention of mother-to-child transmission (PMTCT) of HIV has been adopted across sub-Saharan Africa, but high rates of loss to follow-up (LTF) indicate that, while coverage of antiretroviral therapy (ART) has increased, maternal and infant retention in care is low. However, the National Institutes of Health-funded Safe Generations-Plus study led by ICAP at Columbia University investigated LTF cases at 10 health facilities in “Swaziland“and found that substantial proportions of both women and infants who had been marked as LTF were actually engaged in care. This gap in understanding, the study says, is caused by limitations in the capture and utilization of health facility data.
To better understand true outcomes for these patients, the investigators reviewed the national ART patient database and various paper-based records in facilities, traced patients via phone and in the community, and interviewed patients about the care they and their infants had received.
“What we found was that many, though not all, of the women had been in care and receiving antiretroviral treatment, and many infants had been to facilities and received HIV testing at least one time,” said Bill Reidy, the study’s principal investigator and an epidemiologist with ICAP. “However, we had difficulties reaching many women, and some of those we did reach indicated that they or their infants had not been consistently engaged in care—so work is still needed to strengthen patient tracing systems and promote engagement in these very critical services over time.”
Option B+ is the lifelong provision of ART for all pregnant or breastfeeding women living with HIV, in order to prevent mother-to-child transmission of the virus. The World Health Organization first promoted Option B+ in its “April 2012 programmatic update” on the use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants.
ICAP offers a free online training course for nurses and midwives in Option B+. This resource is available “through ICAP’s website.
“The results of this study not only give us a much more accurate picture of the patient outcomes from these 10 health facilities, but also an idea of what kinds of information could be collected and how to go about it,” said Reidy. “These findings can improve data collection systems, and also inform training and support of clinical and community-based health workers.”
Findings from this study will be presented at CROI on “Wednesday, March 7, 2018
Engagement In Care And Infant HIV Testing Among Lost To Follow-Up Option B+ Patients
Authors: William Reidy, Harriet Nuwagaba-Biribonwoha, Siphesihle Shongwe, Ruben Sahabo, Kieran Hartsough, Simangele Mthethwa, Elaine J Abrams
Presented by: Bill Reidy