Engagement in care among women and their infants lost to follow-up under Option B+ in eSwatini

Reidy, William; Nuwagaba‐Biribonwoha, Harriet; Shongwe, Siphesihle; Sahabo, Ruben; Hartsough, Kieran; Wu, Yingfeng; Gachuhi, Averie B.; Mthethwa-Hleta, Simangele; Abrams, Elaine J.

doi:10.1371/journal.pone.0222959

Cited by 3 publications

(3 citation statements)

References 25 publications

(47 reference statements)

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“…Tracing studies in non-pregnant adults have reported higher rates of successful tracing, several with over 80% outcome ascertainment for the outreached population [ 21 , 30 , 31 ]. In eSwatini, community tracing of women who were LTFU ascertained outcomes in 44.7% of women [ 23 ], while in Malawi only 40% of women LTFU in Option B+ programs were successfully traced [ 24 ]. These low rates of outcome ascertainment highlight the challenges of community tracing of WLWHIV in SSA.…”

Section: Discussionmentioning

confidence: 99%

“…Several tracing studies have addressed the outcomes of non-pregnant adults who have become LTFU [18][19][20][21]. However, other than three studies from Zimbabwe, eSwatini and Malawi, there is a dearth of knowledge about the outcomes of pregnant women initiating ART who subsequently become LTFU [22][23][24]. Such outcomes may include estimates of HIV viral suppression, MTCT and care status among women who disengage from HIV care programs.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of retained and disengaged pregnant women living with HIV in Uganda

et al. 2021

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Introduction Loss-to-follow-up among women living with HIV (WLWHIV) may lead to unfavorable outcomes for both mother and exposed infant. This study traced WLWHIV disengaged from care and their infants and compared their outcomes with those retained in care. Methods The study included WLWHIV who initiated ART during pregnancy at six public clinics in Uganda. A woman was defined as disengaged (DW) if she had not attended her 6-week post-partum visit by 10 weeks after her estimated date of delivery. DW were matched with retained women (RW) by age and duration on ART. Nurse counselors traced all selected DW via telephone and community visits to assess vital status, infant HIV sero-status and maternal HIV viral load through blood draws. Results Between July 2017 and July 2018, 734 women (359 DW and 375 RW) were identified for the study. Tracing was attempted on 349 DW and 160 (44.6%) were successfully located and enrolled in the study. They were matched with 162 RW. Among DW, 52 (32.5%) transferred to another health facility. Very few DW, 39.0% were HIV virally suppressed (<1000 copies/ml) compared to RW 89.5%, P<0.001). Among 138 babies born to DW, 4.3% tested positive for HIV compared to 1.4% among babies born to RW (P = 0.163). Conclusion Pregnant and breastfeeding WLWHIV who disengage from care are difficult to find in urban environments. Many have detectable viral loads, leading to the potential for an increased risk of MTCT. Efforts to reduce disengagement from care are critical for the successful elimination of MTCT in resource-limited settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of retained and disengaged pregnant women living with HIV in Uganda

et al. 2021

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“…More recent data after institution of Option B+, however, show low rates of viral suppression and high losses to follow-up: for example in eSwatini 53% postpartum retention in care [8], in Tanzania 39% viral suppression at 12 months postpartum [9]. Follow-up studies with tracing of women lost to specific clinic follow-up show that some women are in care elsewhere, though overall postpartum retention in care estimates remain sub-optimal [10]. For women retained in care, adherence to therapy remains a challenge.…”

Section: Introductionmentioning

confidence: 99%

Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12‐month cohort study in urban South Africa and rural Uganda

et al. 2020

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Introduction We conducted a cohort study to understand patterns of anti‐retroviral therapy (ART) adherence during pregnancy, postpartum and non‐pregnancy follow‐up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. Methods We collected survey data, continuously monitored ART adherence (Wisepill), HIV‐RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow‐up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non‐pregnancy‐related (neither pregnant nor postpartum). Fractional regression models included demographics and socio‐behavioural factors informed by the Behavioral Model for Vulnerable Populations. We evaluated HIV‐RNA at 12 months by ever‐ versus never‐pregnant status. Results In Uganda, 247 women contributed 676, 900 and 1274 months of pregnancy, postpartum and non‐pregnancy‐related follow‐up. Median ART adherence was consistently ≥90%: pregnancy, 94% (interquartile range [IQR] 78,98); postpartum, 90% (IQR 70,97) and non‐pregnancy, 90% (IQR 80,98). Poorer adherence was associated with younger age (0.98% [95% CI 0.33%, 1.62%] average increase per year of age) and higher CD4 cell count (1.01% [0.08%, 1.94%] average decrease per 50 cells/mm3). HIV‐RNA was suppressed among 91% (N = 135) ever‐pregnant and 86% (N = 85) never‐pregnant women. In South Africa, 190 women contributed 259, 624 and 1247 months of pregnancy, postpartum and non‐pregnancy‐related follow‐up. Median adherence was low during pregnancy, 74% (IQR 31,96); postpartum, 40% (IQR 4,65) and non‐pregnancy, 77% (IQR 47,92). Poorer adherence was associated with postpartum status (22.3% [95%CI 8.6%, 35.4%] average decrease compared to non‐pregnancy‐related follow‐up) and less emotional support (1.4% [0.22%, 2.58%] average increase per unit increase). HIV‐RNA was suppressed among 57% (N = 47) ever‐pregnant and 86% (N = 93) never‐pregnant women. Conclusions Women in rural Uganda maintained high adherence with 91% of ever‐pregnant and 86% of never‐pregnant women suppressing HIV‐RNA at 12 months. Women in urban South Africa struggled with adherence, particularly during postpartum follow‐up with median adherence of 40% and 57% of women with HIV‐RNA suppression at one year, suggesting a crisis for postpartum women with HIV in South Africa. Findings suggest that effective interventions should promote emotional support.

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Engagement in care among women and their infants lost to follow-up under Option B+ in eSwatini

et al. 2019

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Background Universal antiretroviral treatment (ART) for pregnant women with HIV, Option B+, has been adopted widely for prevention of mother-to-child HIV transmission (PMTCT). Some evidence shows high loss to follow-up (LTF) under this model. However, gaps in data systems limit this evidence. We collected additional information for women and infants LTF from Option B+ in Eswatini to assess more accurate outcomes. Methods LTF at 6-months postpartum was assessed using facility data. Additional data was gathered from: 1) the national ART database and paper records; 2) patient tracing; and 3) interviews and abstraction from patient-held records. Engagement in care was defined as any clinic visit within 91 days before or after 6-months postpartum or completion of a documented transfer; or, for those traced but not completing study interviews, visits at 6-months postpartum or later (for infants), or visits within 3-months of tracing (for women). Multivariable loglinear models were used to identify correlates of engagement. Results One-hundred-ninety-four (44.7%) of 434 LTF women had outcomes ascertained, including 122 (62.9%) women engaged in care. Among 510 LTF infants, 265 (52.0%) had ascertained outcomes, including 143 (54.0%) engaged in care, 47 (17.7%) pregnancy losses, and 18 (6.8%) deaths. Seventy-two of 189 live infants (38.1%) with ascertained outcomes had a 6week early infant diagnostic (EID) test. Among women with ascertained outcomes, gestational age of 20+ weeks (vs. fewer than 20 weeks, aRR 0.80; 95% CI 0.68-0.94) and age 25-29 years (vs.

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Engagement in care among women and their infants lost to follow-up under Option B+ in eSwatini

Cited by 3 publications

References 25 publications

Outcomes of retained and disengaged pregnant women living with HIV in Uganda

Outcomes of retained and disengaged pregnant women living with HIV in Uganda

Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12‐month cohort study in urban South Africa and rural Uganda

Engagement in care among women and their infants lost to follow-up under Option B+ in eSwatini

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