title: Implementation and Operational Research: Maternal Combination Antiretroviral Therapy Is Associated With Improved Retention of HIV-Exposed Infants in Kinshasa, Democratic Republic of Congo.
abstract: BACKGROUND
  Programs to prevent mother-to-child HIV transmission are plagued by loss to follow-up (LTFU) of HIV-exposed infants. We assessed if providing combination antiretroviral therapy (cART) to HIV-infected mothers was associated with reduced LTFU of their HIV-exposed infants in Kinshasa, DR Congo.
  
  
  METHODS
  We constructed a cohort of mother-infant pairs using routinely collected clinical data. Maternal cART eligibility was based on national guidelines in effect at the time. Infants were considered LTFU after 3 failed tracking attempts after a missed visit or if more than 6 months passed since they were last seen in clinic. Statistical methods accounted for competing risks (eg, death).
  
  
  RESULTS
  A total of 1318 infants enrolled at a median age of 2.6 weeks (interquartile range: 2.1-6.9), at which point 24% of mothers were receiving cART. Overall, 5% of infants never returned to care after enrollment and 18% were LTFU by 18 months. The 18-month cumulative incidence of LTFU was 8% among infants whose mothers initiated cART by infant enrollment and 20% among infants whose mothers were not yet on cART. Adjusted for baseline factors, infants whose mothers were not on cART were over twice as likely to be LTFU, with a subdistribution hazard ratio of 2.75 (95% confidence limit: 1.81 to 4.16). The association remained strong regardless of maternal CD4 count at infant enrollment.
  
  
  CONCLUSIONS
  Increasing access to cART for pregnant women could improve retention of HIV-exposed infants, thereby increasing the clinical and population-level impacts of prevention of mother-to-child HIV transmission interventions and access to early cART for HIV-infected infants.
authors.affiliation: *Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC; †School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; and ‡Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
authors.forename: Lydia
authors.initials: L
authors.lastname: Feinstein
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.forename: Vitus
authors.initials: V
authors.lastname: Okitolonda
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Papy
authors.initials: P
authors.lastname: Ndjibu
authors.forename: Jean
authors.initials: J
authors.lastname: Lusiama
authors.forename: Jean L
authors.initials: JL
authors.lastname: Chalachala
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D059012:Lost to Follow-Up; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents