title: Pregnant women with HIV in rural Nigeria have higher rates of antiretroviral treatment initiation, but similar loss to follow-up as non-pregnant women and men.
abstract: BACKGROUND
  We examined antiretroviral therapy (ART) initiation and retention by sex and pregnancy status in rural Nigeria.
  
  
  METHODS
  We studied HIV-infected ART-naïve patients aged ≥15 years entering care from June 2009 to September 2013. We calculated the probability of early ART initiation and cumulative incidence of loss to follow-up (LTFU) during the first year of ART, and examined the association between LTFU and sex/pregnancy using Cox regression.
  
  
  RESULTS
  The cohort included 3813 ART-naïve HIV-infected adults (2594 women [68.0%], 273 [11.8%] of them pregnant). The proportion of pregnant clients initiating ART within 90 days of enrollment (78.0%, 213/273) was higher than among non-pregnant women (54.3%,1261/2321) or men (53.0%, 650/1219), both p<0.001. Pregnant women initiated ART sooner than non-pregnant women and men (median [IQR] days from enrollment to ART initiation for pregnant women=7 days [0-21] vs 14 days [7-49] for non-pregnant women and 14 days [7-42] for men; p<0.001). Cumulative incidence of LTFU during the first year post-ART initiation was high and did not differ by sex and pregnancy status. Persons who were unemployed, bedridden, had higher CD4+ counts, and/or in earlier WHO clinical stages were more likely to be LTFU.
  
  
  CONCLUSIONS
  Pregnant women with HIV in rural Nigeria were more likely to initiate ART but were no more likely to be retained in care. Our findings underscore the importance of effective retention strategies across all patient groups, regardless of sex and pregnancy status.
authors.affiliation: Vanderbilt Institute for Global Health Departments of Health Policy muktar.aliyu@vanderbilt.edu.
authors.forename: Muktar H
authors.initials: MH
authors.lastname: Aliyu
authors.affiliation: Vanderbilt Institute for Global Health Department of Biostatistics.
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins
authors.affiliation: Westat, Rockville, MD, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Megazzini
authors.affiliation: Vanderbilt Institute for Global Health Departments of Health Policy.
authors.forename: Deidra D
authors.initials: DD
authors.lastname: Parrish
authors.affiliation: Vanderbilt Institute for Global Health Departments of Health Policy.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Audet
authors.affiliation: Vanderbilt Institute for Global Health Department of Human and Organizational Development.
authors.forename: Naomi
authors.initials: N
authors.lastname: Chan
authors.affiliation: Department of Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-400, Nashville, TN 37203, USA.
authors.forename: Chisom
authors.initials: C
authors.lastname: Odoh
authors.affiliation: Friends for Global Health Initiative, Abuja, Nigeria.
authors.forename: Usman I
authors.initials: UI
authors.lastname: Gebi
authors.affiliation: Friends for Global Health Initiative, Abuja, Nigeria.
authors.forename: Mukhtar Y
authors.initials: MY
authors.lastname: Muhammad
authors.affiliation: Vanderbilt Institute for Global Health Department of Biostatistics.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.affiliation: Vanderbilt Institute for Global Health Department of Medicine.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.affiliation: Vanderbilt Institute for Global Health Department of Pediatrics, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN 37203, USA.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: Antiretroviral therapy; HIV/AIDS; Loss to follow-up; Nigeria; Retention in care