ICAP at Columbia, Mailman School of Public Health.
Vagelos College of Physicians & Surgeons.
AIDS. 2019 Jan 27;33(1):45-54. doi: 10.1097/QAD.0000000000002027.
Universal eligibility for lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') has been widely adopted, but concerns remain. We tested the hypothesis that the change from CD4+-guided ART eligibility ('Option A'), to Option B+, would improve maternal ART uptake and retention.
A stepped-wedge evaluation at 12 health facilities in eSwatini.
Primary outcome was maternal retention: proportion of women attending clinic within 56 days of delivery (antenatal retention) and clinic attendance within 84 days of 6-months postpartum (postnatal retention). Generalized estimating equations examined impact of Option B+ vs. Option A.
Between 19 August 2013 and 29 August 2014, 2347 HIV-positive women, 55% (n = 1296) Option A, 45%, (n = 1051) Option B+ were included. ART initiation was observed in 36% (n = 469) of Option A women vs. 94% (n = 983) under Option B+ (P < 0.001). Overall 39% (n = 912) were retained from first ANC visit through 6-months postpartum. Retention was higher under Option B+ (53%, n = 559) vs. Option A (24%, n = 353) with variation by site and study month. Adjusting for age, gestational age, previous HIV diagnosis, and CD4+, Option B+ women were significantly more likely to be retained antenatally (aRR 1.32; 95% CI 1.18-1.49; P < 0.001) and postnatally (aRR 2.11; 95% CI 1.79-2.49) compared with Option A. Restricted to women initiating ART, retention was lower under Option B+ (57%, n = 558) vs. Option A (66%, n = 309; aRR, 0.82; 95% CI 0.70-0.95; P < 0.0001).
Compared with CD4+-guided ART eligibility, universal ART resulted in substantial increases in pregnant women initiating ART and retained in care through 6 months postpartum.
为孕妇和哺乳期妇女提供终身抗逆转录病毒治疗（ART）的普遍资格（“B+方案”）已被广泛采用，但仍存在一些担忧。我们检验了这样一个假设，即从 CD4+指导的 ART 资格（“A 方案”）转变为 B+方案会提高产妇接受 ART 的比例并保持其接受治疗。
在斯威士兰的 12 个卫生机构进行的阶梯式评估。
主要结局是产妇保留率：分娩后 56 天内到诊所就诊的比例（产前保留率）和产后 6 个月内到诊所就诊的比例（产后保留率）。广义估计方程检验了 B+方案与 A 方案的影响。
2013 年 8 月 19 日至 2014 年 8 月 29 日，纳入了 2347 名 HIV 阳性妇女，55%（n=1296）为 A 方案，45%（n=1051）为 B+方案。在 A 方案中，有 36%（n=469）的妇女开始接受 ART，而在 B+方案中，有 94%（n=983）的妇女开始接受 ART（P<0.001）。总体而言，从首次 ANC 就诊到产后 6 个月，有 39%（n=912）的妇女保留了下来。B+方案（53%，n=559）的保留率高于 A 方案（24%，n=353），且各地点和研究月份存在差异。在调整了年龄、胎龄、既往 HIV 诊断和 CD4+后，与 A 方案相比，B+方案的妇女在产前（ARR 1.32；95%CI 1.18-1.49；P<0.001）和产后（ARR 2.11；95%CI 1.79-2.49）保留率更高。在仅纳入开始接受 ART 的妇女中，B+方案（57%，n=558）的保留率低于 A 方案（66%，n=309；ARR，0.82；95%CI 0.70-0.95；P<0.0001）。
与 CD4+指导的 ART 资格相比，普遍提供 ART 使更多孕妇开始接受 ART 治疗，并在产后 6 个月内保持治疗。
