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, Deborah, Muzambi, Margaret, Nkhata, Misheck J., Abongomera, George, Joseph, Sarah, Ndlovu, Makosonke, Mabugu, Travor, Grundy, Caroline, Chan, Adrienne K., Cataldo, Fabian, Kityo, Cissy, Seeley, Janet, Katabira, Elly, Gilks, Charles F., Reid, Andrew, Hakim, James and Gibb, Diana M. (2017) 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, 74 5: 508-516. doi:10.1097/QAI.0000000000001267


Author Ford, Deborah
Muzambi, Margaret
Nkhata, Misheck J.
Abongomera, George
Joseph, Sarah
Ndlovu, Makosonke
Mabugu, Travor
Grundy, Caroline
Chan, Adrienne K.
Cataldo, Fabian
Kityo, Cissy
Seeley, Janet
Katabira, Elly
Gilks, Charles F.
Reid, Andrew
Hakim, James
Gibb, Diana M.
Title 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 name Journal of Acquired Immune Deficiency Syndromes   Check publisher's open access policy
ISSN 1077-9450
1525-4135
1944-7884
Publication date 2017-04-15
Sub-type Article (original research)
DOI 10.1097/QAI.0000000000001267
Open Access Status Not yet assessed
Volume 74
Issue 5
Start page 508
End page 516
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Abstract Lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (Option B+) was rolled out in Zimbabwe from 2014, with simultaneous raising of the CD4 treatment threshold to 500 cells per cubic millimeter in nonpregnant/breastfeeding adults and children 5 years and over.
Formatted abstract
Background: Lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (Option B+) was rolled out in Zimbabwe from 2014, with simultaneous raising of the CD4 treatment threshold to 500 cells per cubic millimeter in nonpregnant/breastfeeding adults and children 5 years and over.

Methods: Lablite is an implementation project in Zimbabwe, Malawi, and Uganda evaluating ART rollout. Routine patient-level data were collected for 6 months before and 12 months after Option B+ rollout at a district hospital and 3 primary care facilities in Zimbabwe (2 with outreach ART and 1 with no ART provision before Option B+).

Results: Between September 2013 and February 2015, there were 1686 ART initiations in the 4 facilities: 91% adults and 9% children younger than 15 years. In the 3 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 World Health Organization stage 3/4 or CD4 ≤350 per cubic millimeter (64% for CD4 ≤500). Seventy-four men (22%) and 123 nonpregnant/breastfeeding women (34%) 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).

Conclusions: There were increased ART initiations in all patient groups after implementation of World Health Organization 2013 guidelines. Retention of Option B+ women was poorer than retention of other adults; younger women require attention because they are more likely to disengage from care.
Keyword Antiretroviral therapy
CD4 threshold
Decentralization
Option B+
Primary health care
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID MC_UU_12023/17
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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