title: ART attrition and risk factors among Option B+ patients in Haiti: A retrospective cohort study.
abstract: OBJECTIVE
  In October 2012, the Haitian Ministry of Health endorsed the "Option B+" strategy to eliminate mother-to-child transmission of HIV and achieve HIV epidemic control. The objective of this paper is to assess and identify risk factors for attrition from the national ART program among Option B+ patients in the 12 months after ART initiation.
  
  
  METHODS
  This retrospective cohort study included patients newly initiating ART from October 2012-August 2013 at 68 ART sites covering 45% of all newly enrolled ART patients in all regions of Haiti.
  
  
  METHODS
  With data from electronic medical records, we carried out descriptive analysis of sociodemographic, clinical, and pregnancy-related correlates of ART attrition, and used a modified Poisson regression approach to estimate relative risks in a multivariable model.
  
  
  RESULTS
  There were 2,166 Option B+ patients who initiated ART, of whom 1,023 were not retained by 12 months (47.2%). One quarter (25.3%) dropped out within 3 months of ART initiation. Protective factors included older age, more advanced HIV disease progression, and any adherence counseling prior to ART initiation, while risk factors included starting ART late in gestation, starting ART within 7 days of HIV testing, and using an atypical ART regimen.
  
  
  CONCLUSIONS
  Our study demonstrates early ART attrition among Option B+ patients and contributes evidence on the characteristics of women who are most at risk of attrition in Haiti. Our findings highlight the importance of targeted strategies to support retention among Option B+ patients.
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Nancy
authors.identifier: http://orcid.org/0000-0002-6693-9278
authors.initials: N
authors.lastname: Puttkammer
authors.affiliation: US Centers for Disease Control and Prevention, Port au Prince, Haiti.
authors.forename: Jean Wysler
authors.initials: JW
authors.lastname: Domerçant
authors.affiliation: US Centers for Disease Control and Prevention, Kampala, Uganda.
authors.forename: Michelle
authors.initials: M
authors.lastname: Adler
authors.affiliation: Center for AIDS Research, University of Washington, Seattle, Washington, United States of America.
authors.forename: Krista
authors.initials: K
authors.lastname: Yuhas
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Martine
authors.initials: M
authors.lastname: Myrtil
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Young
authors.affiliation: Ministry of Public Health and Population, Government of Haiti, Port au Prince, Haiti.
authors.forename: Kesner
authors.initials: K
authors.lastname: François
authors.affiliation: Ministry of Public Health and Population, Government of Haiti, Port au Prince, Haiti.
authors.forename: Reynold
authors.initials: R
authors.lastname: Grand'Pierre
authors.affiliation: US Centers for Disease Control and Prevention, Port au Prince, Haiti.
authors.forename: David
authors.initials: D
authors.lastname: Lowrance
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission*; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011159:Population Surveillance; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome