Characteristics and outcomes of women initiating ART during pregnancy versus breastfeeding in Option B+ in Malawi

BMC Public Health

Research Article

C. Meaney¹  A. Matengeni²  M. van Lettow³  M. Landes⁴  S. Sodhi⁴  J. J. van Oosterhout⁵  A. K. Chan⁶ 

[1] Department of Family and Community Medicine, University of Toronto, Toronto, Canada;Dignitas International, Zomba, Malawi;Dignitas International, Zomba, Malawi;Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;Dignitas International, Zomba, Malawi;Department of Family and Community Medicine, University of Toronto, Toronto, Canada;Dignitas International, Zomba, Malawi;Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi;Dignitas International, Zomba, Malawi;Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada;

关键词: Option B+;    Prevention of mother to child transmission of HIV;    ART initiation;    Malawi;    Pregnancy;    Breastfeeding;    HIV;   

DOI  :  10.1186/s12889-016-3380-7

 received in 2015-12-03, accepted in 2016-07-27,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundMalawi adopted the PMTCT strategy ‘Option B+’ in 2011, providing life-long ART for all HIV-infected pregnant and breastfeeding women. We explored differences in characteristics and outcomes of women initiating ART during pregnancy versus breastfeeding.MethodsWe conducted a retrospective cohort analysis of women in Zomba District, southern Malawi, from January 2012- September 2013. Data were extracted from the Zomba District Observational Cohort Study, a surveillance project collecting data from standardized Ministry of Health ART monitoring tools.Results1986 (67.2 %) women initiated ART during pregnancy and 969 (32.8 %) during breastfeeding. Women initiating ART in breastfeeding were more likely to be > 30 years (aOR = 1.33, 95 % CI1.11–1.59, p = 0.003) and have WHO Stage 3/4 (aOR = 2.74, 95 % CI1.94–3.87, p < 0.001).Eighteen (0.6 %) deaths occurred and 942 (31.9 %) women defaulted ART. ‘Early’ death (< 30 days) occurred in 3 (0.1 %) women and 449 (16.4 %) women defaulted early. Death/default < 30 days was more likely among women initiating ART during pregnancy (aOR 1.62, 95 % CI1.28–2.05, p < 0.001) or < 30 years old (aOR 1.27, 95 % CI 1.02–1.57, p = 0.03) and was less likely among those with WHO Stage 3/4 (aOR 0.30, 95 % CI 0.15–0.60, p < 0.001).Using Kaplan-Meier estimators to investigate time to death/default, we showed a sharp drop in death/default-free survival probability at time zero, yet survival probability decreased in a nearly linear manner after this initial period of high default. Women under 30 years had increased rates of death/default over time (log rank test: p < 0.001), however no significant differences were observed in death/default over time associated with timing of ART initiation, documented clinical stage at initiation, health clinic size or adherence rates.ConclusionsMany women in Malawi started ART during breastfeeding within Option B+ and were older and had more advanced WHO Clinical Staging. This represents a missed PMTCT opportunity to initiate treatment early in pregnancy. Early defaulting is identified as a challenge within Option B+, and was more likely among younger women and those initiating ART in pregnancy. Targeted research to understand factors associated with uptake of ART during pregnancy and retention in care could improve the efficacy of Option B+ in Malawi.

【 授权许可】

CC BY   
© The Author(s). 2016