Pascal N Atanga1,2, Harrison T Ndetan3,4, Eric A Achidi5, Henry D Meriki6,7, Michael Hoelscher2,8, Arne Kroidl2,9. 1. Department of Public Health and Hygiene, University of Buea, Buea, Cameroon. 2. Centre for International Health, University of Munich, Munich, Germany. 3. Research Institute, Parker University, Dallas, TX, USA. 4. Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA. 5. Faculty of Sciences, University of Buea, Buea, Cameroon. 6. Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon. 7. Laboratory Department, Regional Hospital Buea, Buea, Cameroon. 8. Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany. 9. German Centre for Infection Research, Partner Site Munich, Munich, Germany.
Abstract
OBJECTIVE: To assess linkage and retention in care along the PMTCT cascade in HIV-positive pregnant and breastfeeding women initiating Option B+ in Cameroon. METHODS: We prospectively determined uptake of HIV testing and counselling (HTC), uptake of ART and retention in care after Option B+ initiation between October 2013 and December 2014 in pregnant and breastfeeding women from five sites within the Kumba Health District. Retention in care was assessed over at least 12 months follow-up and estimated by Kaplan-Meier analysis. During follow-up, tracing outcomes and reasons for discontinuing treatment were documented. RESULTS: The uptake of HTC of 5813 women with unknown HIV status was 98.5%, 251 (4.4%) were newly diagnosed HIV positive, and ART uptake in women eligible to start Option B+ was 96.8%. We enrolled 268 women initiating lifelong ART in the follow-up. Overall, 65 (24.3%) discontinued treatment, either defined by loss to follow-up (44.6%) or actively stopped treatment (55.8%). Retention in care was 88.0% and 81.1% at 6 and 12 months, respectively. Discontinuation was significantly associated in multivariate analysis with small sites and high staff turnover [aOR 2.5 (95% CI 1.6, 3.9), P < 0.001]. Main reasons for stopping treatment were HIV status denial and stigma (52.8%), religious reasons (25.0%) and lack of transport fare (11.1%). CONCLUSION: We observed good uptake of HTC, ART and retention in care, which declined over time. Discontinuation of Option B+ was highest at small sites with a high staff turnover. Improved staffing, adequate task shifting and community interventions to track defaulters including reducing stigma and religious beliefs may improve Option B+ retention.
OBJECTIVE: To assess linkage and retention in care along the PMTCT cascade in HIV-positive pregnant and breastfeeding women initiating Option B+ in Cameroon. METHODS: We prospectively determined uptake of HIV testing and counselling (HTC), uptake of ART and retention in care after Option B+ initiation between October 2013 and December 2014 in pregnant and breastfeeding women from five sites within the Kumba Health District. Retention in care was assessed over at least 12 months follow-up and estimated by Kaplan-Meier analysis. During follow-up, tracing outcomes and reasons for discontinuing treatment were documented. RESULTS: The uptake of HTC of 5813 women with unknown HIV status was 98.5%, 251 (4.4%) were newly diagnosed HIV positive, and ART uptake in women eligible to start Option B+ was 96.8%. We enrolled 268 women initiating lifelong ART in the follow-up. Overall, 65 (24.3%) discontinued treatment, either defined by loss to follow-up (44.6%) or actively stopped treatment (55.8%). Retention in care was 88.0% and 81.1% at 6 and 12 months, respectively. Discontinuation was significantly associated in multivariate analysis with small sites and high staff turnover [aOR 2.5 (95% CI 1.6, 3.9), P < 0.001]. Main reasons for stopping treatment were HIV status denial and stigma (52.8%), religious reasons (25.0%) and lack of transport fare (11.1%). CONCLUSION: We observed good uptake of HTC, ART and retention in care, which declined over time. Discontinuation of Option B+ was highest at small sites with a high staff turnover. Improved staffing, adequate task shifting and community interventions to track defaulters including reducing stigma and religious beliefs may improve Option B+ retention.
Authors: Brandon A Knettel; Cody Cichowitz; James Samwel Ngocho; Elizabeth T Knippler; Lilian N Chumba; Blandina T Mmbaga; Melissa H Watt Journal: J Acquir Immune Defic Syndr Date: 2018-04-15 Impact factor: 3.731
Authors: Cody Cichowitz; Festo Mazuguni; Linda Minja; Prosper Njau; Gretchen Antelman; James Ngocho; Brandon A Knettel; Melissa H Watt; Blandina T Mmbaga Journal: AIDS Behav Date: 2019-07
Authors: Benjamin H Chi; Wilbroad Mutale; Jennifer Winston; Winifreda Phiri; Joan T Price; Angel Mwiche; Helen Ayles; Jeffrey S A Stringer Journal: Pediatr Infect Dis J Date: 2018-11 Impact factor: 2.129
Authors: Melissa H Watt; Cody Cichowitz; Godfrey Kisigo; Linda Minja; Brandon A Knettel; Elizabeth T Knippler; James Ngocho; Preeti Manavalan; Blandina T Mmbaga Journal: AIDS Care Date: 2018-11-22
Authors: Pascal N Atanga; Harrison T Ndetan; Peter N Fon; Henry D Meriki; Tih P Muffih; Eric A Achidi; Michael Hoelscher; Arne Kroidl Journal: BMC Pregnancy Childbirth Date: 2018-10-25 Impact factor: 3.007