title: Implementation of Antiretroviral Therapy for Life in Pregnant/Breastfeeding HIV+ Women (Option B+) Alongside Rollout and Changing Guidelines for ART Initiation in Rural Zimbabwe: The Lablite Project Experience.
abstract: Lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (Option B+) was rolled out in Zimbabwe from 2014, with simultaneous raising of the CD4 treatment threshold to 500 cells per cubic millimeter in nonpregnant/breastfeeding adults and children 5 years and over.
  
  
  
  Lablite is an implementation project in Zimbabwe, Malawi, and Uganda evaluating ART rollout. Routine patient-level data were collected for 6 months before and 12 months after Option B+ rollout at a district hospital and 3 primary care facilities in Zimbabwe (2 with outreach ART and 1 with no ART provision before Option B+).
  
  
  
  Between September 2013 and February 2015, there were 1686 ART initiations in the 4 facilities: 91% adults and 9% children younger than 15 years. In the 3 facilities with established ART, initiations rose from 300 during 6 months before Option B+ to 869 (2.9-fold) and 463 (1.5-fold), respectively, 0-6 months and 6-12 months after Option B+. Post-Option B+, an estimated 43% of pregnant/breastfeeding women needed ART for their own health, based on World Health Organization stage 3/4 or CD4 ≤350 per cubic millimeter (64% for CD4 ≤500). Seventy-four men (22%) and 123 nonpregnant/breastfeeding women (34%) initiated ART with CD4 >350 after the CD4 threshold increase. Estimated 12-month retention on ART was 79% (69%-87%) in Option B+ women (significantly lower in younger women, P = 0.01) versus 93% (91%-95%) in other adults (difference P < 0.001).
  
  
  
  There were increased ART initiations in all patient groups after implementation of World Health Organization 2013 guidelines. Retention of Option B+ women was poorer than retention of other adults; younger women require attention because they are more likely to disengage from care.
authors.affiliation: *MRC Clinical Trials Unit at University College London, London, United Kingdom; †University of Zimbabwe, Harare, Zimbabwe; ‡Dignitas International, Zomba, Malawi; §Joint Clinical Research Centre, Kampala, Uganda; ‖Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; ¶MRC/UVRI Uganda Research Unit of AIDS, Entebbe, Uganda; #Infectious Diseases Institute, Makerere University, Mulago, Uganda; and **School of Population Health, University of Queensland, Queensland, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Ford
authors.forename: Margaret
authors.initials: M
authors.lastname: Muzambi
authors.forename: Misheck J
authors.initials: MJ
authors.lastname: Nkhata
authors.forename: George
authors.initials: G
authors.lastname: Abongomera
authors.forename: Sarah
authors.initials: S
authors.lastname: Joseph
authors.forename: Makosonke
authors.initials: M
authors.lastname: Ndlovu
authors.forename: Travor
authors.initials: T
authors.lastname: Mabugu
authors.forename: Caroline
authors.initials: C
authors.lastname: Grundy
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Chan
authors.forename: Fabian
authors.initials: F
authors.lastname: Cataldo
authors.forename: Cissy
authors.initials: C
authors.lastname: Kityo
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Charles F
authors.initials: CF
authors.lastname: Gilks
authors.forename: Andrew
authors.initials: A
authors.lastname: Reid
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012424:Rural Population; D014944:World Health Organization; D015030:Zimbabwe
chemical_list: D044966:Anti-Retroviral Agents