Engagement in care among women and their infants lost to follow-up under Option B+ in eSwatini

Autoři: William Reidy aff001;  Harriet Nuwagaba-Biribonwoha aff001;  Siphesihle Shongwe aff001;  Ruben Sahabo aff001;  Kieran Hartsough aff001;  Yingfeng Wu aff001;  Averie Gachuhi aff001;  Simangele Mthethwa-Hleta aff003;  Elaine J. Abrams aff001
Působiště autorů: ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, New York, United States of America aff001;  Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, United States of America aff002;  Ministry of Health, Mbabane, Eswatini aff003;  Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, United States of America aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222959



Universal antiretroviral treatment (ART) for pregnant women with HIV, Option B+, has been adopted widely for prevention of mother-to-child HIV transmission (PMTCT). Some evidence shows high loss to follow-up (LTF) under this model. However, gaps in data systems limit this evidence. We collected additional information for women and infants LTF from Option B+ in Eswatini to assess more accurate outcomes.


LTF at 6-months postpartum was assessed using facility data. Additional data was gathered from: 1) the national ART database and paper records; 2) patient tracing; and 3) interviews and abstraction from patient-held records. Engagement in care was defined as any clinic visit within 91 days before or after 6-months postpartum or completion of a documented transfer; or, for those traced but not completing study interviews, visits at 6-months postpartum or later (for infants), or visits within 3-months of tracing (for women). Multivariable loglinear models were used to identify correlates of engagement.


One-hundred-ninety-four (44.7%) of 434 LTF women had outcomes ascertained, including 122 (62.9%) women engaged in care. Among 510 LTF infants, 265 (52.0%) had ascertained outcomes, including 143 (54.0%) engaged in care, 47 (17.7%) pregnancy losses, and 18 (6.8%) deaths. Seventy-two of 189 live infants (38.1%) with ascertained outcomes had a 6-week early infant diagnostic (EID) test. Among women with ascertained outcomes, gestational age of 20+ weeks (vs. fewer than 20 weeks, aRR 0.80; 95% CI 0.68–0.94) and age 25–29 years (vs. 15–24 years, aRR 0.81; 95% CI 0.67–0.97), were associated with lower engagement; initiating ART after first ANC visit was associated with higher engagement (vs. at first ANC visit, aRR 1.12; 95% CI 1.04–1.21). Among infants with ascertained outcomes, mother not initiating ART was associated with lower engagement (vs. ART at first ANC visit, aRR 0.71; 95% CI 0.54–0.91).


Substantial numbers of women and infants classified as LTF under Option B+ were engaged in care, though a suboptimal level of 6-week EID testing was observed. These findings highlight a need to improve coverage of routine EID testing, and improve data systems to better capture PMTCT patient outcomes.

Klíčová slova:

Age groups – Antenatal care – Global health – Infants – Pregnancy – Telephones


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2019 Číslo 10
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