Featured news from NHIVNA
HIV-related news from NAM
'Option B+' women are at increased risk of loss to follow-up after starting HIV treatment
Lesley Odendal, 2013-07-10 16:00:00
Women who begin HIV treatment during pregnancy, or while breastfeeding, prior to the CD4 cell threshold previously recommended for starting treatment (350 cells), were significantly more likely to be lost to follow-up than women who started treatment at the general treatment threshold, Malawian researchers reported last week at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur.
Initiating treatment during pregnancy or while breastfeeding when a woman has a high CD4 count, above 350 cells/mm3, is referred to as Option B+ in World Health Organization and national guidelines.
Option B+ was first conceived and implemented in Malawi where the national ART programme had already been functioning well using a public health approach which did not depend heavily on CD4 testing to determine who should initiate treatment. Malawi envisioned that Option B+ would be easier to implement due to its simple 'one size fits all' approach which would enable women to access antiretroviral treatment in settings with poor access to CD4 testing.
The analysis presented at the conference looked at the outcomes of all women in Malawi who started treatment in the fourth quarter of 2011 and the first quarter of 2012. A total of 21,939 patient records from 540 sites were included.
In total, 17% of all Option B+ patients were lost to follow-up six months after ARV initiation. Option B+ patients who initiated ARVs during pregnancy were five times more likely to not return to the clinics after their initial visit than patients who started with a low CD4 cell count and/or in WHO clinical stage 3 or 4 (OR 5.2, 95% CI: 4.4-6.2).
Option B+ patients who started treatment while breastfeeding, were twice as likely to miss their first follow-up visit (OR 2.3, 95% CI: 1.8-2.8).
Pregnant Option B+ patients who initiated ARVs on the day they were diagnosed as HIV-infected were less likely to return to clinics than pregnant Option B+ patients who started subsequently (OR 1.7, 95% CI: 1.4-2.2).
Altogether, 37% of the sites performed well, with fewer than 10% of all patients lost to follow-up six months after ARV initiation. However, 33% of the sites had a loss-to-follow-up rate of more than 20%.
Loss to follow-up was somewhat higher at sites operated by the Ministry of Health, compared to sites managed by faith-based organisations (OR 1.19, 95% CI: 0.94-1.5, p=0.04). Patients receiving ARVs at central hospitals were 2.7 times more likely to be lost to follow-up than those treated at health centers (OR2.7, 95% CI: 0.92-7.94, p=0.047).
Source:1
