title: Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B.
abstract: Background. Preventing mother-to-child transmission of HIV relies on engagement in care during the prenatal, peripartum, and postpartum periods. Under PMTCT Option B, pregnant women with elevated CD4 counts are provided with antiretroviral prophylaxis until cessation of breastfeeding. Methods. Retrospective analysis of retention in care among HIV-infected pregnant women in Haiti was performed. Logistic regression was used to identify risk factors associated with loss to follow-up (LFU) defined as no medical visit for at least 6 months and Kaplan-Meier curves were created to show LFU timing. Results. Women in the cohort had 463 pregnancies between 2009 and 2012 with retention rates of 80% at delivery, 67% at one year, and 59% at 2 years. Among those who were LFU, the highest risk period was during pregnancy (60%) or shortly afterwards (24.4% by 12 months). Never starting on antiretroviral therapy (aRR 2.29, 95% CI 1.4-3.8) was associated with loss to follow-up. Conclusions. Loss to follow-up during and after pregnancy was common in HIV-infected women in Haiti under PMTCT Option B. Since sociodemographic factors and distance from home to facility did not predict LFU, future work should elicit and address barriers to retention at the initial prenatal care visit in all women. Better tracking systems to capture engagement in care in the wider network are needed.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jodie
authors.identifier: 0000-0002-3625-5174
authors.initials: J
authors.lastname: Dionne-Odom
authors.affiliation: Boston University School of Medicine, Boston, MA, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Massaro
authors.affiliation: Geisel School of Medicine, Hanover, NH, USA.
authors.forename: Kristen M
authors.identifier: 0000-0001-6032-5219
authors.initials: KM
authors.lastname: Jogerst
authors.affiliation: Biostatistics Shared Resource, Norris Cotton Cancer Center, Dartmouth College, Lebanon, NH, USA.
authors.forename: Zhongze
authors.initials: Z
authors.lastname: Li
authors.affiliation: Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Marie-Marcelle
authors.initials: MM
authors.lastname: Deschamps
authors.affiliation: Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Cleonas Junior
authors.initials: CJ
authors.lastname: Destine
authors.affiliation: Immaculate Conception Hospital, Les Cayes, Haiti.
authors.forename: Redouin
authors.initials: R
authors.lastname: Senecharles
authors.affiliation: Immaculate Conception Hospital, Les Cayes, Haiti.
authors.forename: Moleine Moles
authors.initials: MM
authors.lastname: Aristhene
authors.affiliation: Immaculate Conception Hospital, Les Cayes, Haiti.
authors.forename: Joseph Yves
authors.initials: JY
authors.lastname: Domercant
authors.affiliation: Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rouzier
authors.affiliation: Geisel School of Medicine, Hanover, NH, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Wright