title: Retention in care of HIV-infected pregnant and lactating women starting ART under Option B+ in rural Mozambique.
abstract: OBJECTIVE
  In 2013, Mozambique adopted Option B+, universal lifelong antiretroviral therapy (ART) for all pregnant and lactating women, as national strategy for prevention of mother-to-child transmission of HIV. We analysed retention in care of pregnant and lactating women starting Option B+ in rural northern Mozambique.
  
  
  METHODS
  We compared ART outcomes in pregnant ('B+ pregnant'), lactating ('B+ lactating') and non-pregnant non-lactating women of childbearing age starting ART according to clinical and/or immunological criteria ('own health') between July 2013 and June 2014. Lost to follow-up was defined as no contact >180 days after the last visit. Multivariable competing risk models were adjusted for type of facility (type 1 vs. peripheral type 2 health centre), age, WHO stage and time from HIV diagnosis to ART.
  
  
  RESULTS
  Over 333 person-years of follow-up (243 'B+ pregnant', 65'B+ lactating' and 317 'own health' women), 3.7% of women died and 48.5% were lost to follow-up. 'B+ pregnant' and 'B+ lactating' women were more likely to be lost in the first year (57% vs. 56.9% vs. 31.6%; P < 0.001) and to have no follow-up after the first visit (42.4% vs. 29.2% vs. 16.4%; P < 0.001) than 'own health' women. In adjusted analyses, risk of being lost to follow-up was higher in 'B+ pregnant' (adjusted subhazard ratio [asHR]: 2.77; 95% CI: 2.18-3.50; P < 0.001) and 'B+ lactating' (asHR: 1.94; 95% CI: 1.37-2.74; P < 0.001). Type 2 health centre was the only additional significant risk factor for loss to follow-up.
  
  
  CONCLUSIONS
  Retention among PLW starting option B+ ART was poor and mainly driven by early losses. The success of Option B+ for prevention of mother-to-child transmission of HIV in rural settings with weak health systems will depend on specific improvements in counselling and retention measures, especially at the beginning of treatment.
authors.affiliation: SolidarMed, Ancuabe, Mozambique.
authors.forename: Jara
authors.initials: J
authors.lastname: Llenas-García
authors.affiliation: SolidarMed, Ancuabe, Mozambique.
authors.forename: Philip
authors.initials: P
authors.lastname: Wikman-Jorgensen
authors.affiliation: SolidarMed, Luzern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Hobbins
authors.affiliation: Health Provincial Directorate, Operational Research Nucleus of Pemba, Pemba, Mozambique.
authors.forename: Manuel Aly
authors.initials: MA
authors.lastname: Mussa
authors.affiliation: SolidarMed, Luzern, Switzerland.
authors.forename: Jochen
authors.initials: J
authors.lastname: Ehmer
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
authors.affiliation: National Health Institute, Maputo, Mozambique.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mbofana
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.|Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
keywords: 
  HIV
  ; 
  PTME
  ; 
  VIH
  ; Afrique du Sud; Opción B+; Option B+; prevención de la transmisión madre-hijo; prevention of mother-to-child transmission; retención en cuidados; retention in care; rural Southern Africa; rétention dans les soins; salud de la mujer; santé des femmes; sur de África rural; women's health; zone rurale