Impact of universal antiretroviral therapy for pregnant and postpartum women on antiretroviral therapy uptake and retention

摘要

Supplemental Digital Content is available in the text Objective: Universal eligibility for lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (’Option B+’) has been widely adopted, but concerns remain. We tested the hypothesis that the change from CD4~(+)-guided ART eligibility (’Option A’), to Option B+, would improve maternal ART uptake and retention. Design: A stepped-wedge evaluation at 12 health facilities in eSwatini. Methods: Primary outcome was maternal retention: proportion of women attending clinic within 56 days of delivery (antenatal retention) and clinic attendance within 84 days of 6-months postpartum (postnatal retention). Generalized estimating equations examined impact of Option B+ vs. Option A. Results: Between 19 August 2013 and 29 August 2014, 2347 HIV-positive women, 55% ( n ?=?1296) Option A, 45%, ( n ?=?1051) Option B+ were included. ART initiation was observed in 36% ( n ?=?469) of Option A women vs. 94% ( n ?=?983) under Option B+ ( P ?