title: Retention, transfer out and loss to follow-up two years after delivery in a cohort of HIV+ pregnant women in Malawi.
abstract: In this study, we analysed in a cohort of pregnant women followed for two years the proportion of women remaining at the same clinic, those who transferred to other clinics, and those lost to follow-up. The possible determinants of the loss to follow-up were also assessed in a setting of postpartum discontinuation based on CD4+ count. A total of 311 pregnant women received antiretroviral therapy from week 25 of gestational age until six months postpartum (end of breastfeeding period), or indefinitely if meeting the criteria for treatment (baseline CD4+ <350 cells/mm(3)). Twenty-four months after delivery, six women had died, 247 were in active follow-up, 21 had transferred to another antiretroviral therapy clinic and 37 were lost to follow-up (rate of loss to follow-up 13%, 95% CI 9.1-16.9%). The presence of a baseline CD4+ count above 350 cells/mm(3) was associated with a ten-fold higher risk of loss to follow-up after six months of delivery (hazard ratio: 9.8, 95% CI 2.2-42.7, for baseline CD4 >350 cells/mm(3) versus baseline CD4+ count below 350 cells/mm(3), p = 0.002). This finding suggests that discontinuation of drugs when the risk of transmission has ceased can have a negative impact on the retention in care of these women.
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy marina.giuliano@iss.it.
authors.forename: Marina
authors.initials: M
authors.lastname: Giuliano
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liotta
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Andreotti
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mancinelli
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Ersilia
authors.initials: E
authors.lastname: Buonomo
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Scarcella
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Amici
authors.affiliation: DREAM Program, Community of S. Egidio, Blantyre, Malawi.
authors.forename: Haswel
authors.initials: H
authors.lastname: Jere
authors.affiliation: DREAM Program, Community of S. Egidio, Blantyre, Malawi.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Sagno
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Di Gregorio
authors.affiliation: LUMSA University, Rome, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marazzi
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Vella
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D059012:Lost to Follow-Up; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010360:Patient Transfer; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D037841:Pregnant People / Q000523:psychology*; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; Africa; HAART; HIV; antenatal care; pregnancy; prevention; retention in care; treatment; women