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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, D; Muzambi, M; Nkhata, MJ; Abongomera, A; Joseph, S; Ndlovu, M; Mabugu, T; ... Lablite Team, .; + view all (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. JAIDS: Journal of Acquired Immune Deficiency Syndromes , 74 (5) pp. 508-516. 10.1097/QAI.0000000000001267. Green open access

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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.

Type: Article
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
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAI.0000000000001267
Publisher version: http://dx.doi.org/10.1097/QAI.0000000000001267
Language: English
Additional information: This version is the version of record. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: antiretroviral therapy, Option B+, CD4 threshold, decentralization, primary health care
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > UCL SLASH
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS > SHS Faculty Office
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS > SHS Faculty Office > UCL Institute for Advanced Studies
URI: https://discovery.ucl.ac.uk/id/eprint/1529318
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