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Studies probe retention in HIV care for women who start antiretroviral treatment during pregnancy
Carole Leach-Lemens, 2016-03-01 14:30:00

Engaging lay counsellors to provide a combination package of evidence-based interventions in Nyanza, Kenya and addressing partner disclosure, as well as pre-treatment education about the benefits of antiretroviral therapy (ART) for maternal and child health in Malawi’s Option B+ programme, improved retention in care and reduced loss to follow-up of mothers with HIV and their infants, studies presented last week at the Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston show.

Poor retention in care of mothers with HIV and their infants across the prevention of mother-to-child transmission (PMTCT)/paediatric care continuum continues to undermine what is otherwise a remarkable success. If retention is not adequately addressed, programme success and maternal and infant health are threatened.

In resource-poor settings, studies have shown 17% of pregnant women with HIV initiated on ART do not return after their first antenatal care visit; one third of women with HIV who give birth in a clinic are lost to follow-up three months after delivery.

Reports have described the unique needs – including treatment literacy of postpartum women with HIV – to be addressed if they are to return to and/or be retained in care.

Simplification of PMTCT services and adoption of Option B+ (the availability of lifelong treatment regardless of CD4 count for pregnant and breastfeeding women with HIV) in many countries, notably Malawi, have had extraordinary success in significantly reducing the number of vertical (from mother to child) transmissions. However, loss to follow-up (LTFU) among women enrolled onto treatment as a result of Option B+ in Malawi is as high as 29% after a year.

Several studies presented at CROI 2016 looked at reasons for loss to follow-up among mothers enrolled on antiretroviral treatment, and interventions to improve retention.