[Accepted Manuscript] Implementation of antiretroviral therapy for life in pregnant/breastfeeding HIV+ women (Option B+) alongside rollout and changing guidelines for ART initiation in rural Zimbabwe: the Lablite Project experience


Ford, D.; Muzambi, M.; Nkhata, M.J.; Abongomera, G.; Joseph, S.; Ndlovu, M.; Mabugu, T.; Grundy, C.; Chan, A.K.; Cataldo, F.; Kityo, C.; Seeley, J.; Katabira, E.; Gilks, C.F.; Reid, A.; Hakim, J.; Gibb, D.M.; Lablite Team, .; (2016) [Accepted Manuscript] Implementation of antiretroviral therapy for life in pregnant/breastfeeding HIV+ women (Option B+) alongside rollout and changing guidelines for ART initiation in rural Zimbabwe: the Lablite Project experience. Journal of acquired immune deficiency syndromes (1999). ISSN 1525-4135 DOI: https://doi.org/10.1097/QAI.0000000000001267 (In Press)

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Abstract

Life-long ART for pregnant and breastfeeding women (Option B+) was rolled-out in Zimbabwe from 2014 with simultaneous raising of the CD4 treatment-threshold in non-pregnant/breastfeeding adults and children >5 years to 500 cells/mm. Lablite is an implementation project in Zimbabwe, Malawi and Uganda evaluating ART rollout. Routine patient-level data were collected for 6 months prior to and 12 months after Option B+ rollout at a district hospital and three primary care facilities in Zimbabwe (two with outreach ART; one with no ART provision prior to Option B+). Between September 2013-February 2015 there were 1,686 ART initiations in the four facilities; 91% adults and 9% children aged <15 years. In the three facilities with established ART, initiations rose from 300 during 6 months before Option B+ to 869 (2.9-fold) and 463 (1.5-fold) respectively 0-6 months and 6-12 months after Option B+. Post Option B+, an estimated 43% of pregnant/breastfeeding women needed ART for their own health, based on WHO stage 3/4 or CD4≤350 (64% for CD4≤500). 74 (22%) men and 123 (34%) non-pregnant/breastfeeding women initiated ART with CD4>350 after the CD4-threshold increase. Estimated 12-month retention on ART was 79% (69%-87%) in Option B+ women (significantly lower in younger women, p=0.01), versus 93% (91%-95%) in other adults (difference p<0.001). There were increased ART initiations in all patient groups following implementation of WHO 2013 guidelines. Retention of Option B+ women was poorer than retention of other adults; younger women require attention as they are more likely to disengage from care.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Faculty of Public Health and Policy > Dept of Global Health and Development
URI: http://researchonline.lshtm.ac.uk/id/eprint/3298878

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