Departments of Epidemiology; Global Health, University of Washington, Seattle, WA.
Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2023 Feb 1;92(2):106-114. doi: 10.1097/QAI.0000000000003117.
Prevention of mother-to-child transmission programs serve women continuing and initiating antiretroviral therapy (ART) in pregnancy, and follow-up schedules align to delivery rather than ART initiation, making conventional HIV retention measures (assessed from ART initiation) challenging to apply. We evaluated 3 measures of peripartum nonretention in Kenyan women living with HIV from pregnancy to 2 years postpartum.
This longitudinal analysis used programmatic data from the Mobile WAChX trial (NCT02400671). Outcomes included loss to follow-up (LTFU) (no visit for ≥6 months), incomplete visit coverage (<80% of 3-month intervals with a visit), and late visits (>2 weeks after scheduled date). Predictors of nonretention were determined using Cox proportional hazards, log-binomial, and generalized estimating equation models.
Among 813 women enrolled at a median of 24 weeks gestation, incidence of LTFU was 13.6/100 person-years; cumulative incidence of LTFU by 6, 12, and 24 months postpartum was 16.7%, 20.9%, and 22.5%, respectively. Overall, 35.5% of women had incomplete visit coverage. Among 794 women with 12,437 scheduled visits, a median of 11.1% of visits per woman were late (interquartile range 4.3%-23.5%). Younger age, unsuppressed viral load, unemployment, ART initiation in pregnancy, and nondisclosure were associated with nonretention by all measures. Partner involvement was associated with better visit coverage and timely attendance. Women who became LTFU had higher frequency of previous late visits (16.7% vs. 7.7%, P < 0.0001).
Late visit attendance may be a sentinel indicator of LTFU. Identified cofactors of prevention of mother-to-child transmission programmatic retention may differ depending on retention measure assessed, highlighting the need for standardized measures.
母婴传播预防项目为正在妊娠及开始接受抗逆转录病毒治疗（ART）的妇女提供服务，随访时间表与分娩相关，而不是与 ART 开始相关，这使得传统的 HIV 保留措施（从 ART 开始评估）难以应用。我们评估了肯尼亚 HIV 阳性孕妇到产后 2 年期间的三种围产期保留措施。
这项纵向分析使用了来自 Mobile WAChX 试验（NCT02400671）的项目数据。结局包括失访（未进行≥6 个月的随访）、就诊覆盖率不完整（就诊间隔的 3 个月中＜80%）和就诊延迟（超过预约日期后 2 周）。采用 Cox 比例风险、对数二项和广义估计方程模型确定非保留的预测因素。
在中位妊娠 24 周时入组的 813 名妇女中，失访率为 13.6/100 人年；产后 6、12 和 24 个月时的累积失访率分别为 16.7%、20.9%和 22.5%。总体而言，35.5%的妇女就诊覆盖率不完整。在 794 名有 12437 次预约的妇女中，中位数为 11.1%的预约（四分位间距 4.3%-23.5%）延迟。年龄较小、病毒载量未抑制、失业、妊娠时开始 ART 和未透露身份与所有措施的非保留相关。伴侣参与与更好的就诊覆盖率和及时就诊相关。失访的妇女之前有更多的延迟就诊（16.7%比 7.7%，P<0.0001）。
延迟就诊可能是失访的一个先兆指标。母婴传播预防项目保留的已识别共同因素可能因评估的保留措施而异，这突出了标准化措施的必要性。
