Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania
Abstract Introduction To prevent vertical HIV transmission and ensure healthy mothers and children, pregnant women with HIV must remain on antiretroviral treatment (ART) for life. However, motivation to remain on ART may decline beyond the standard 2‐year breastfeeding/postpartum period. We assessed...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26186 |
| _version_ | 1827340760518754304 |
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| author | Roseline Faustine Urrio Goodluck Willey Lyatuu David Sando Michael J. Mahande Emmanuel Philipo Helga Naburi Peter Lyaruu Amanda Kimonge Kasasi Mayogu Brenda Simba Ayoub Muhamed Kibao Michael Msangi Zangin Zeebari Gunnel Biberfeld Anna Mia Ekström Charles Kilewo Anna E. Kågesten |
| author_facet | Roseline Faustine Urrio Goodluck Willey Lyatuu David Sando Michael J. Mahande Emmanuel Philipo Helga Naburi Peter Lyaruu Amanda Kimonge Kasasi Mayogu Brenda Simba Ayoub Muhamed Kibao Michael Msangi Zangin Zeebari Gunnel Biberfeld Anna Mia Ekström Charles Kilewo Anna E. Kågesten |
| author_sort | Roseline Faustine Urrio |
| collection | DOAJ |
| description | Abstract Introduction To prevent vertical HIV transmission and ensure healthy mothers and children, pregnant women with HIV must remain on antiretroviral treatment (ART) for life. However, motivation to remain on ART may decline beyond the standard 2‐year breastfeeding/postpartum period. We assessed attrition and retention in ART care among women with HIV up to 6 years since enrolment in vertical transmission prevention services in Dar es Salaam, Tanzania. Methods A prospective cohort of 22,631 pregnant women with HIV were enrolled in vertical transmission prevention services between January 2015 and December 2017 in routine healthcare settings and followed‐up to July 2021. Kaplan−Meier was used to estimate time to ART attrition (died, stopped ART or was lost to follow‐up [no show ≥90 days since scheduled appointment]) and the proportion retained in care. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) of ART attrition in relation to predictors. Results Participants were followed‐up to 6 years for a median of 3 years (IQR: 0.1–4). The overall ART attrition rate was 13.8 per 100 person‐years (95% CI: 13.5–14.1), highest in the first year of enrolment at 27.1 (26.3–27.9), thereafter declined to 9.5 (8.9–10.1) in year 3 and 2.7 (2.1–3.5) in year 6. The proportion of women retained in care were 78%, 69%, 63%, 60%, 57% and 56% at 1, 2, 3, 4, 5 and 6 years, respectively. ART attrition was higher in young women aged <20 years (aHR 1.63, 95% CI: 1.38–1.92) as compared to 30‐39 year‐olds and women enrolled late in the third versus first trimester (aHR 1.29, 95% CI: 1.16–1.44). In contrast, attrition was lower in older women ≥40 years, women who initiated ART before versus during the index pregnancy and women attending higher‐level health facilities. Conclusions ART attrition among women with HIV remains highest in the first year of enrolment in vertical transmission prevention services and declines markedly following a transition to chronic HIV care. Targeted interventions to improve ART continuity among women with HIV during and beyond prevention of vertical transmission are vital to ending paediatric HIV and keeping women and children alive and healthy. |
| first_indexed | 2024-03-07T21:25:12Z |
| format | Article |
| id | doaj.art-b82f250326894645b467becfbad9a83c |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-03-07T21:25:12Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-b82f250326894645b467becfbad9a83c2024-02-27T05:18:27ZengWileyJournal of the International AIDS Society1758-26522024-02-01272n/an/a10.1002/jia2.26186Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, TanzaniaRoseline Faustine Urrio0Goodluck Willey Lyatuu1David Sando2Michael J. Mahande3Emmanuel Philipo4Helga Naburi5Peter Lyaruu6Amanda Kimonge7Kasasi Mayogu8Brenda Simba9Ayoub Muhamed Kibao10Michael Msangi11Zangin Zeebari12Gunnel Biberfeld13Anna Mia Ekström14Charles Kilewo15Anna E. Kågesten16Management and Development for Health Dar es Salaam TanzaniaManagement and Development for Health Dar es Salaam TanzaniaManagement and Development for Health Dar es Salaam TanzaniaManagement and Development for Health Dar es Salaam TanzaniaManagement and Development for Health Dar es Salaam TanzaniaDepartment of Pediatric and Child Health Muhimbili University of Health and Allied Sciences Dar es Salaam TanzaniaManagement and Development for Health Dar es Salaam TanzaniaManagement and Development for Health Dar es Salaam TanzaniaManagement and Development for Health Dar es Salaam TanzaniaManagement and Development for Health Dar es Salaam TanzaniaOffice of the Regional Administrative Secretary Dar es Salaam TanzaniaMinistry of Health Dodoma TanzaniaDepartment of Global Public Health Karolinska Institutet Stockholm SwedenDepartment of Global Public Health Karolinska Institutet Stockholm SwedenDepartment of Global Public Health Karolinska Institutet Stockholm SwedenDepartment of Obstetrics and Gynacology Muhimbili University of Health and Allied Sciences Dar es Salaam TanzaniaDepartment of Global Public Health Karolinska Institutet Stockholm SwedenAbstract Introduction To prevent vertical HIV transmission and ensure healthy mothers and children, pregnant women with HIV must remain on antiretroviral treatment (ART) for life. However, motivation to remain on ART may decline beyond the standard 2‐year breastfeeding/postpartum period. We assessed attrition and retention in ART care among women with HIV up to 6 years since enrolment in vertical transmission prevention services in Dar es Salaam, Tanzania. Methods A prospective cohort of 22,631 pregnant women with HIV were enrolled in vertical transmission prevention services between January 2015 and December 2017 in routine healthcare settings and followed‐up to July 2021. Kaplan−Meier was used to estimate time to ART attrition (died, stopped ART or was lost to follow‐up [no show ≥90 days since scheduled appointment]) and the proportion retained in care. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) of ART attrition in relation to predictors. Results Participants were followed‐up to 6 years for a median of 3 years (IQR: 0.1–4). The overall ART attrition rate was 13.8 per 100 person‐years (95% CI: 13.5–14.1), highest in the first year of enrolment at 27.1 (26.3–27.9), thereafter declined to 9.5 (8.9–10.1) in year 3 and 2.7 (2.1–3.5) in year 6. The proportion of women retained in care were 78%, 69%, 63%, 60%, 57% and 56% at 1, 2, 3, 4, 5 and 6 years, respectively. ART attrition was higher in young women aged <20 years (aHR 1.63, 95% CI: 1.38–1.92) as compared to 30‐39 year‐olds and women enrolled late in the third versus first trimester (aHR 1.29, 95% CI: 1.16–1.44). In contrast, attrition was lower in older women ≥40 years, women who initiated ART before versus during the index pregnancy and women attending higher‐level health facilities. Conclusions ART attrition among women with HIV remains highest in the first year of enrolment in vertical transmission prevention services and declines markedly following a transition to chronic HIV care. Targeted interventions to improve ART continuity among women with HIV during and beyond prevention of vertical transmission are vital to ending paediatric HIV and keeping women and children alive and healthy.https://doi.org/10.1002/jia2.26186vertical HIV transmissionantiretroviral treatment (ART)attritionretentionpregnant/breastfeeding womenadolescent and young women |
| spellingShingle | Roseline Faustine Urrio Goodluck Willey Lyatuu David Sando Michael J. Mahande Emmanuel Philipo Helga Naburi Peter Lyaruu Amanda Kimonge Kasasi Mayogu Brenda Simba Ayoub Muhamed Kibao Michael Msangi Zangin Zeebari Gunnel Biberfeld Anna Mia Ekström Charles Kilewo Anna E. Kågesten Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania Journal of the International AIDS Society vertical HIV transmission antiretroviral treatment (ART) attrition retention pregnant/breastfeeding women adolescent and young women |
| title | Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania |
| title_full | Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania |
| title_fullStr | Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania |
| title_full_unstemmed | Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania |
| title_short | Long‐term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania |
| title_sort | long term retention on antiretroviral treatment after enrolment in prevention of vertical hiv transmission services a prospective cohort study in dar es salaam tanzania |
| topic | vertical HIV transmission antiretroviral treatment (ART) attrition retention pregnant/breastfeeding women adolescent and young women |
| url | https://doi.org/10.1002/jia2.26186 |
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