title: One-year outcomes of women started on antiretroviral therapy during pregnancy before and after the implementation of Option B+ in Malawi: A retrospective chart review.
abstract: OBJECTIVE
  To compare one-year outcomes of women started on antiretroviral therapy (ART) during pregnancy in the pre-Option B+ era to those in the Option B+ era.
  
  
  METHODS
  A retrospective chart review was performed at three sites in Malawi. Women were included in the 'pre-Option B+' cohort if they started ART during pregnancy for a CD4 count < 350 cells/mm3or WHO 3/4 condition and in the 'Option B+' cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher's exact and ANOVA F-tests.
  
  
  RESULTS
  A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%,P< 0.001), switched ART regimens (5.9% versus 0%,P= 0.002), or died in the first year after starting treatment (3.9% versus .5%,P= 0.05). While more women in the Option B+ cohort had poor adherence or defaulted, these differences were not significant.
  
  
  CONCLUSIONS
  At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.
authors.affiliation: Department of Pathology, College of Medicine, Blantyre, Malawi Mahatma Gandhi Road Blantyre, Malawi.
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Kamuyango
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
authors.affiliation: Department of Statistics, University of California, Los Angeles, PO Box 951736, Los Angeles, CA, 90095, USA.
authors.forename: Wenjia
authors.initials: W
authors.lastname: Wang
authors.affiliation: Partners in Hope Medical Centre, PO Box 302, Lilongwe, Malawi.
authors.forename: Perry
authors.initials: P
authors.lastname: Jansen
authors.affiliation: Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, David Geffen School of Medicine, 10833 Le Conte Ave, 37-121 CHS, Los Angeles, California, 90095 USA.
authors.forename: Risa M
authors.initials: RM
authors.lastname: Hoffman
keywords: antiretroviral therapy; option B+; pregnancy; prevention of mother-to-child transmission