James T Pfeiffer1, Manuel Napúa, Bradley H Wagenaar, Falume Chale, Roxanne Hoek, Mark Micek, João Manuel, Cathy Michel, Jessica Greenberg Cowan, James F Cowan, Sarah Gimbel, Kenneth Sherr, Stephen Gloyd, Rachel R Chapman. 1. *Department of Global Health, University of Washington, Seattle, WA; †Health Alliance International, Seattle, WA; ‡Department of Anthropology, University of Washington, Seattle, WA; §Ministry of Health, Beira Operational Research Center, Beira, Mozambique; ‖Health Alliance International, Beira, Mozambique; ¶Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI; #Department of Family Medicine, University of Washington, Seattle, WA; and **Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA.
Abstract
BACKGROUND: This randomized trial studied performance of Option B+ in Mozambique and evaluated an enhanced retention package in public clinics. SETTING: The study was conducted at 6 clinics in Manica and Sofala Provinces in central Mozambique. METHODS:Seven hundred sixty-one pregnant women tested HIV+, immediately initiated antiretroviral (ARV) therapy, and were followed to track retention at 6 clinics from May 2014 to May 2015. Clinics were randomly allocated within a stepped-wedge fashion to intervention and control periods. The intervention included (1) workflow modifications and (2) active patient tracking. Retention was defined as percentage of patients returning for 30-, 60-, and 90-day medication refills within 25-35 days of previous refills. RESULTS: During control periods, 52.3% of women returned for 30-day refills vs. 70.8% in intervention periods [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.05 to 3.08]. At 60 days, 46.1% control vs. 57.9% intervention were retained (OR: 1.82; CI: 1.06 to 3.11), and at 90 days, 38.3% control vs. 41.0% intervention (OR: 1.04; CI: 0.60 to 1.82). In prespecified subanalyses, birth before pickups was strongly associated with failure-women giving birth before ARV pickup were 33.3 times (CI: 4.4 to 250.3), 7.5 times (CI: 3.6 to 15.9), and 3.7 times (CI: 2.2 to 6.0) as likely to not return for ARV pickups at 30, 60, and 90 days, respectively. CONCLUSIONS: The intervention was effective at 30 and 60 days, but not at 90 days. Combined 90-day retention (40%) and adherence (22.5%) were low. Efforts to improve retention are particularly important for women giving birth before ARV refills.
RCT Entities:
BACKGROUND: This randomized trial studied performance of Option B+ in Mozambique and evaluated an enhanced retention package in public clinics. SETTING: The study was conducted at 6 clinics in Manica and Sofala Provinces in central Mozambique. METHODS: Seven hundred sixty-one pregnant women tested HIV+, immediately initiated antiretroviral (ARV) therapy, and were followed to track retention at 6 clinics from May 2014 to May 2015. Clinics were randomly allocated within a stepped-wedge fashion to intervention and control periods. The intervention included (1) workflow modifications and (2) active patient tracking. Retention was defined as percentage of patients returning for 30-, 60-, and 90-day medication refills within 25-35 days of previous refills. RESULTS: During control periods, 52.3% of women returned for 30-day refills vs. 70.8% in intervention periods [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.05 to 3.08]. At 60 days, 46.1% control vs. 57.9% intervention were retained (OR: 1.82; CI: 1.06 to 3.11), and at 90 days, 38.3% control vs. 41.0% intervention (OR: 1.04; CI: 0.60 to 1.82). In prespecified subanalyses, birth before pickups was strongly associated with failure-women giving birth before ARV pickup were 33.3 times (CI: 4.4 to 250.3), 7.5 times (CI: 3.6 to 15.9), and 3.7 times (CI: 2.2 to 6.0) as likely to not return for ARV pickups at 30, 60, and 90 days, respectively. CONCLUSIONS: The intervention was effective at 30 and 60 days, but not at 90 days. Combined 90-day retention (40%) and adherence (22.5%) were low. Efforts to improve retention are particularly important for women giving birth before ARV refills.
Authors: Maureen Braun; Mark M Kabue; Eric D McCollum; Saeed Ahmed; Maria Kim; Leela Aertker; Marko Chirwa; Michael Eliya; Innocent Mofolo; Irving Hoffman; Peter N Kazembe; Charles van der Horst; Mark W Kline; Mina C Hosseinipour Journal: J Acquir Immune Defic Syndr Date: 2011-04-15 Impact factor: 3.731
Authors: Bradley H Wagenaar; Sarah Gimbel; Roxanne Hoek; James Pfeiffer; Cathy Michel; Fatima Cuembelo; Titos Quembo; Pires Afonso; Stephen Gloyd; Barrot H Lambdin; Mark A Micek; Victoria Porthé; Kenneth Sherr Journal: Glob Health Action Date: 2016-08-30 Impact factor: 2.640
Authors: Malia Duffy; Caitlin Madevu-Matson; Jessica E Posner; Hana Zwick; Melissa Sharer; Antonia M Powell Journal: Trop Med Int Health Date: 2022-04-01 Impact factor: 3.918