Stepped-Wedge Cluster Randomized Controlled Trial to Promote Option B+ Retention in Central Mozambique

Pfeiffer, James; Napua, Manuel; Wagenaar, Bradley H.; Chale, Falume; Hoek, Roxanne; Micek, Mark A.; Manuel, José; Michel, Cathy; Cowan, Jessica Greenberg; Cowan, James; Gimbel, Sarah; Sherr, Kenneth; Gloyd, Stephen; Chapman, Rachel R.

doi:10.1097/qai.0000000000001515

Cited by 9 publications

(12 citation statements)

References 38 publications

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“…Interestingly, time effects came into play in the determination of the risks of attrition in our study. In the early years of Option B+ implementation (2013-2014), we did not observe a higher risk of immediate drop-out in pregnant women compared with women on ART for their own health, as observed elsewhere [7,8,18]. Conversely, in 2015, the risk of immediate drop-out was significantly lower among the 'B+ pregnant' women than 'own health' women.…”

Section: Discussionsupporting

confidence: 73%

“…However, emerging studies from the early years of B+ implementation indicated poor retention in women who had initiated ART under the new strategy. In Central Mozambique, less than 45% of women were retained at 90 days after ART initiation [7,8]. It was suggested that women with ART initiation under Option B+ were significantly likelier to be lost to follow-up in the first year or have no follow-up after their first visit than those who initiated ART for their own health [9].…”

Section: Introductionmentioning

confidence: 99%

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PMTCT care cascade and factors associated with attrition in the first four years after Option B+ implementation in Mozambique

Ahoua

Tiendrebeogo

Arikawa

et al. 2019

Tropical Med Int Health

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objective To evaluate the effectiveness of the prevention of mother-to-child transmission (PMTCT) Option B+ programme in two provinces with high human immunodeficiency virus (HIV) burden in Mozambique over the first four years of programme implementation.methods We assessed the PMTCT cascade in antenatal care (ANC) from July 2013 to December 2017 using facility-level data and performed a retrospective cohort analysis with patient-level data. We compared the 12-month antiretroviral therapy (ART) retention rates between women with HIV infection who initiated ART under Option B+ ('B+ pregnant') and those who initiated ART for their own health ('own health').results A total of 916 280 pregnant women enrolled in ANC. The proportion of women with a documented HIV status increased from 93% in 2013 to 96% in 2017. The proportion of those tested HIV-positive decreased from 8% to 6% while that of those HIV-positive on ART increased from 42% to 95%. Of the 44 377 HIV-positive women included in the analysis, 35% were lost to care. 'B+ pregnant' women initiating ART in 2015 were less likely to have no follow-up (NFU) compared with 'own health' women starting ART during the same period (adjusted odds ratio: 0.77, 95% confidence interval [CI]: 0.64-0.94, P = 0.01). There was no statistical difference between the two groups during the other years in which ART was initiated. Of those returning for care after their first visit (N = 39 801), the 'B+ pregnant' women showed a higher risk of non-retention than the other group (adjusted hazard ratio: 1.14, 95% CI: 1.03-1.25) when ART was initiated in 2013. The risk decreased during the subsequent years, with no difference observed between the groups.conclusion PMTCT Option B+ programme scale-up has yielded positive results, including the maintenance of high HIV testing and ART initiation rates in ANC. Challenges still remain, however, in improving immediate engagement in care and long-term retention. Seeking alternative service delivery models to support existing health systems and prevent defaulters is required to achieve the UNAIDS 95-95-95 targets for PMTCT in Mozambique.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

PMTCT care cascade and factors associated with attrition in the first four years after Option B+ implementation in Mozambique

Ahoua

Tiendrebeogo

Arikawa

et al. 2019

Tropical Med Int Health

View full text Add to dashboard Cite

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“…Notably, only two papers presented age-disaggregated results [26,27] and one additional paper noted that age did not modify the study results [28]. Among all 37 papers evaluating at least one approach to increase retention, 18 demonstrated no effect on retention [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 19 reported a significant effect on retention [26][27][28][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Notably, several papers reported significant improvements in retention at some time points but not at others; these are categorized as reporting a significant effect on retention.…”

Section: Resultsmentioning

confidence: 99%

“…One study was published during 2010 [30], but the remainder were published between 2014 and 2020. Cluster-randomized controlled trials were the most common study design [29,32,[34][35][36][37]39,40,43,47,[56][57][58], and the duration of follow-up across studies ranged from one month [28,30,33,61] to 36 to 60 months' postpartum [38], with two-thirds of studies following women through ≤6 months' postpartum [27,28,30,31,33,[35][36][37][39][40][41][43][44][45]47,48,50,[53][54][55][56][59][60][61][62]. Many studies were restricted to women who were not yet receiving ART when presenting for ANC or delivery, and 12 studies were restricted to women who were aged ≥18 years at enrolment in the study [26,28,29,…”

Section: Resultsmentioning

confidence: 99%

“…Alongside the MIR4Health, BEAP and continuous quality improvement studies described above, five other studies demonstrated the effectiveness of combination interventions, but it is not possible to identify the most effective intervention components. These components included integrated care [47,50], active follow-up and tracing [50,54,56,57] and enhanced support through counselling [54,56] or support groups [57]. The duration of follow-up in most of these studies was short, ranging from increased retention during the antenatal period [50,56] to increased retention at six weeks' [54] and 12 weeks' postpartum [47]; only one study reported outcomes through two years [57].…”

Section: Studies Examining Interventions Among Wlhiv Of All Agesmentioning

confidence: 99%

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Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

et al. 2021

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Introduction: Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV. Methods: Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported agedisaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years. Results and discussion: Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results. Conclusions: This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/ or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.

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HIV treatment in pregnancy

et al. 2018

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Stepped-Wedge Cluster Randomized Controlled Trial to Promote Option B+ Retention in Central Mozambique

Abstract: The intervention was effective at 30 and 60 days, but not at 90 days. Combined 90-day retention (40%) and adherence (22.5%) were low. Efforts to improve retention are particularly important for women giving birth before ARV refills.

Cited by 9 publications

References 38 publications

PMTCT care cascade and factors associated with attrition in the first four years after Option B+ implementation in Mozambique

PMTCT care cascade and factors associated with attrition in the first four years after Option B+ implementation in Mozambique

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

HIV treatment in pregnancy

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