Impact of universal antiretroviral therapy for pregnant and postpartum women on antiretroviral therapy uptake and retention.
AIDS
; 33(1): 45-54, 2019 01 27.
Article
en En
| MEDLINE
| ID: mdl-30289804
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 eSwatini.METHODS:
Primary outcome was maternal retention proportion 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+ vs. Option A.RESULTS:
Between 19 August 2013 and 29 August 2014, 2347 HIV-positive women, 55% (nâ=â1296) Option A, 45%, (nâ=â1051) Option B+ were included. ART initiation was observed in 36% (nâ=â469) of Option A women vs. 94% (nâ=â983) under Option B+ (Pâ<â0.001). Overall 39% (nâ=â912) were retained from first ANC visit through 6-months postpartum. Retention was higher under Option B+ (53%, nâ=â559) vs. Option A (24%, nâ=â353) 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; Pâ<â0.001) 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%, nâ=â558) vs. Option A (66%, nâ=â309; aRR, 0.82; 95% CI 0.70-0.95; Pâ<â0.0001).CONCLUSION:
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.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Complicaciones Infecciosas del Embarazo
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Infecciones por VIH
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Terapia Antirretroviral Altamente Activa
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Antirretrovirales
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Utilización de Medicamentos
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Cumplimiento de la Medicación
Límite:
Adolescent
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Adult
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Female
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Humans
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Pregnancy
Idioma:
En
Revista:
AIDS
Asunto de la revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Año:
2019
Tipo del documento:
Article