title: How Can the Health System Retain Women in HIV Treatment for a Lifetime? A Discrete Choice Experiment in Ethiopia and Mozambique.
abstract: BACKGROUND
  Option B+, an approach that involves provision of antiretroviral therapy (ART) to all HIV-infected pregnant women for life, is the preferred strategy for prevention of mother to child transmission of HIV. Lifelong retention in care is essential to its success. We conducted a discrete choice experiment in Ethiopia and Mozambique to identify health system characteristics preferred by HIV-infected women to promote continuity of care.
  
  
  METHODS
  Women living with HIV and receiving care at hospitals in Oromia Region, Ethiopia and Zambézia Province, Mozambique were shown nine choice cards and asked to select one of two hypothetical health facilities, each with six varying characteristics related to the delivery of HIV services for long term treatment. Mixed logit models were used to estimate the influence of six health service attributes on choice of clinics.
  
  
  RESULTS
  2,033 women participated in the study (response rate 97.8% in Ethiopia and 94.7% in Mozambique). Among the various attributes of structure and content of lifelong ART services, the most important attributes identified in both countries were respectful provider attitude and ability to obtain non-HIV health services during HIV-related visits. Availability of counseling support services was also a driver of choice. Facility type, i.e., hospital versus health center, was substantially less important.
  
  
  CONCLUSIONS
  Efforts to enhance retention in HIV care and treatment for pregnant women should focus on promoting respectful care by providers and integrating access to non-HIV health services in the same visit, as well as continuing to strengthen counseling.
authors.affiliation: Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Riley
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Anton M
authors.initials: AM
authors.lastname: Palma
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Sweta
authors.initials: S
authors.lastname: Adhikari
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Laurence
authors.initials: L
authors.lastname: Ahoua
authors.affiliation: Center for Population and Health Research, Maputo, Mozambique.
authors.forename: Carlos
authors.initials: C
authors.lastname: Arnaldo
authors.affiliation: Mozambique Ministry of Health, Maputo, Mozambique.
authors.forename: Dercio F
authors.initials: DF
authors.lastname: Belo
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Serena
authors.initials: S
authors.lastname: Brusamento
authors.affiliation: Mozambique Ministry of Health, Maputo, Mozambique.
authors.forename: Luisa I G
authors.initials: LI
authors.lastname: Cumba
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dziuban
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Wafaa M
authors.initials: WM
authors.lastname: El-Sadr
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Yoseph
authors.initials: Y
authors.lastname: Gutema
authors.affiliation: Oromio Regional Health Bureau, Ethiopia Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Zelalem
authors.initials: Z
authors.lastname: Habtamu
authors.affiliation: Centers for Disease Control and Prevention, Addis Ababa, Ethiopia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Heller
authors.affiliation: Miz-Hasab Research Center, Addis Ababa, Ethiopia.
authors.forename: Aklilu
authors.initials: A
authors.lastname: Kidanu
authors.affiliation: Centers for Disease Control and Prevention, Maputo, Mozambique.
authors.forename: Judite
authors.initials: J
authors.lastname: Langa
authors.affiliation: Mozambique Ministry of Health, Maputo, Mozambique.
authors.forename: Epifanio
authors.initials: E
authors.lastname: Mahagaja
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Carey F
authors.initials: CF
authors.lastname: McCarthy
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Zenebe
authors.initials: Z
authors.lastname: Melaku
authors.affiliation: Centers for Disease Control and Prevention, Maputo, Mozambique.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shodell
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Fatima
authors.initials: F
authors.lastname: Tsiouris
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Young
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rabkin
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D009073:Mozambique; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D037841:Pregnant People