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Retention and adherence in PMTCT programs

Retention and adherence in PMTCT programs. PEPFAR workshop on ART in Pregnancy, Breastfeeding, and Beyond 18-20 June, 2012. Key questions. Are pregnant women on ART more or less likely to be LTFU than non-pregnant women? Are pregnant women typically adherent with ARVs?

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Retention and adherence in PMTCT programs

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  1. Retention and adherence in PMTCT programs PEPFAR workshop on ART in Pregnancy, Breastfeeding, and Beyond 18-20 June, 2012

  2. Key questions • Are pregnant women on ART more or less likely to be LTFU than non-pregnant women? • Are pregnant women typically adherent with ARVs? • What can we do about it?

  3. Stringer, E. M. et al. JAMA 2010;304:293-302

  4. Key questions • Are pregnant women on ART more or less likely to be LTFU than non-pregnant women? • Are pregnant women typically adherent with ARVs? • What can we do about it?

  5. N=~30,000 women from 6 South African sites Myer L et al. 19th CROI, Abs 22

  6. Myer L et al. 19th CROI, Abs 22

  7. Myer L et al. 19th CROI, Abs 22

  8. Myer L et al. 19th CROI, Abs 22

  9. ICAP cohort data Lamb et al, 2011. HIV-positive youth at ICAP-supported HIV clinics. http://www.columbia-icap.org/news/Data Bytes/Databytes June 2011.pdf

  10. % females 19yo who have started childbearing DHS Data

  11. N: 284 rural Zambian women • P-value: 0.11 • Short course AZT/sdNVP (SOC) • ART + infant proph for BF Gartland M, Chi B et al. Abs 23LB

  12. Key questions • Are pregnant women on ART more or less likely to be LTFU than non-pregnant women? • Are pregnant women typically adherent with ARVs? • What can we do about it?

  13. Adherence: A pooled analysis • 51 studies with over 20,000 HIV-infected pregnant women included • Definition of “good adherence” varied across studies (>80%, >90%, >95%, 100%) • _____ had “adequate” ART adherence. Nachega J et al. Abstract 1006

  14. Adherence: A pooled analysis • 51 studies with over 20,000 HIV-infected pregnant women on ART included • Definition of “good adherence” varied across studies (>80%, >90%, >95%, 100%) • 73.5% had “adequate” ART adherence. Nachega J et al. Abstract 1006

  15. Nachega J et al. Abstract 1006

  16. Key questions • Are pregnant women on ART more or less likely to be LTFU than non-pregnant women? • Are pregnant women typically adherent with ARVs? • What can we do about it?

  17. What do we do to improve retention and adherence? • Black, V., R. M. Hoffman, et al. (2008). "Safety and efficacy of initiating highly active antiretroviral therapy in an integrated antenatal and HIV clinic in Johannesburg, South Africa." Journal of acquired immune deficiency syndromes 49(3): 276-281. • Ciampa, P. J., J. R. Burlison, et al. (2011). "Improving retention in the early infant diagnosis of HIV program in rural Mozambique by better service integration." Journal of acquired immune deficiency syndromes 58(1): 115-119. • Killam, W. P., B. C. Tambatamba, N. Chintu, et al. 2010. Antiretroviral Therapy in Antenatal Care to Increase Treatment Initiation in HIV Infected Pregnant Women: A Stepped-Wedge Evaluation. AIDS 24(1):85–91. • Myer, L., R. Zulliger, et al. (2012). "Pilot programme for the rapid initiation of antiretroviral therapy in pregnancy in Cape Town, South Africa." AIDS Care.

  18. What do we do to improve retention and adherence? • Community adherence support groups (Moz) • Facility-based social support (RSA) • SMS/phone support (Namibia) • “The field feedback loop” (Malawi)

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