title: Family matters: Co-enrollment of family members into care is associated with improved outcomes for HIV-infected women initiating antiretroviral therapy.
abstract: BACKGROUND
  Although there is widespread interest in understanding how models of care for delivering antiretroviral therapy (ART) may influence patient outcomes, family-focused approaches have received little attention. In particular, there have been few investigations of whether the co-enrollment of HIV-infected family members may improve adult ART outcomes over time.
  
  
  METHODS
  We examined the association between co-enrollment of HIV-infected family members into care and outcomes of women initiating ART in 12 HIV care and treatment programs across sub-Saharan Africa. Using data from the mother-to-child transmission-(MTCT) Plus Initiative, women starting ART were categorized according to the co-enrollment of an HIV-infected partner and/or HIV-infected child within the same program. Mortality and loss to follow-up were assessed for up to 5 years after women's ART initiation.
  
  
  RESULTS
  Of the 2877 women initiating ART included in the analysis, 31% (n = 880) had at least 1 HIV-infected family member enrolled into care at the same program, including 24% (n = 689) who had an HIV-infected male partner, and 10% (n = 295) who had an HIV-infected child co-enrolled. There was no significant difference in the risk of death of women by family co-enrollment status (P = 0.286). However, the risk of loss to follow-up was greatest among women who did not have an HIV-infected family member co-enrolled (19% after 36 months on ART) compared with women who had an HIV-infected family member co-enrolled (3%-8% after 36 months on ART) (P < 0.001). These associations persisted after adjustment for demographic and clinical covariates and were consistent across countries and care programs.
  
  
  CONCLUSIONS
  These data provide novel evidence for the association between adult outcomes on ART and co-enrollment of HIV-infected family members into care at the same program. Interventions that build on women's family contexts warrant further consideration in both research and policies to promote retention in ART services across sub-Saharan Africa.
authors.affiliation: *Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; ‡ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY; §College of Physicians & Surgeons, Columbia University, New York, NY; ‖Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; and ¶UNICEF, New York, NY.
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jimmy
authors.initials: J
authors.lastname: Duong
authors.forename: Wafaa M
authors.initials: WM
authors.lastname: El-Sadr
authors.forename: Rosalind J
authors.initials: RJ
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005190:Family / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents