Management and Development for Health, Dar es Salaam, Tanzania.
Department of Obstetrics and Gynacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
J Int AIDS Soc. 2024 Feb;27(2):e26186. doi: 10.1002/jia2.26186.
INTRODUCTION: To prevent vertical HIV transmission and ensure healthy mothers and children, pregnant women with HIV must remain on antiretroviral treatment (ART) for life. However, motivation to remain on ART may decline beyond the standard 2-year breastfeeding/postpartum period. We assessed attrition and retention in ART care among women with HIV up to 6 years since enrolment in vertical transmission prevention services in Dar es Salaam, Tanzania. METHODS: A prospective cohort of 22,631 pregnant women with HIV were enrolled in vertical transmission prevention services between January 2015 and December 2017 in routine healthcare settings and followed-up to July 2021. Kaplan-Meier was used to estimate time to ART attrition (died, stopped ART or was lost to follow-up [no show ≥90 days since scheduled appointment]) and the proportion retained in care. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) of ART attrition in relation to predictors. RESULTS: Participants were followed-up to 6 years for a median of 3 years (IQR: 0.1-4). The overall ART attrition rate was 13.8 per 100 person-years (95% CI: 13.5-14.1), highest in the first year of enrolment at 27.1 (26.3-27.9), thereafter declined to 9.5 (8.9-10.1) in year 3 and 2.7 (2.1-3.5) in year 6. The proportion of women retained in care were 78%, 69%, 63%, 60%, 57% and 56% at 1, 2, 3, 4, 5 and 6 years, respectively. ART attrition was higher in young women aged <20 years (aHR 1.63, 95% CI: 1.38-1.92) as compared to 30-39 year-olds and women enrolled late in the third versus first trimester (aHR 1.29, 95% CI: 1.16-1.44). In contrast, attrition was lower in older women ≥40 years, women who initiated ART before versus during the index pregnancy and women attending higher-level health facilities. CONCLUSIONS: ART attrition among women with HIV remains highest in the first year of enrolment in vertical transmission prevention services and declines markedly following a transition to chronic HIV care. Targeted interventions to improve ART continuity among women with HIV during and beyond prevention of vertical transmission are vital to ending paediatric HIV and keeping women and children alive and healthy.
简介：为了预防母婴垂直传播 HIV 并确保母婴健康，HIV 感染孕妇必须终生接受抗逆转录病毒治疗（ART）。然而，在标准的 2 年母乳喂养/产后期间过后，继续接受 ART 的动机可能会下降。我们评估了坦桑尼亚达累斯萨拉姆在垂直传播预防服务中登记的 HIV 感染孕妇在 6 年时间内的 ART 护理中断和保留情况。 方法：2015 年 1 月至 2017 年 12 月，在常规医疗保健环境中，前瞻性队列纳入了 22631 名 HIV 感染孕妇，参与垂直传播预防服务，并随访至 2021 年 7 月。采用 Kaplan-Meier 法估计 ART 中断（死亡、停止 ART 或失访[未出现≥预约后 90 天]）和保留在护理中的比例。采用 Cox 比例风险模型估计与预测因素相关的 ART 中断的调整后风险比（aHR）。 结果：研究参与者的中位随访时间为 3 年（IQR：0.1-4），随访至 6 年。总的 ART 中断率为每 100 人年 13.8 例（95%CI：13.5-14.1），在登记后的第一年最高，为 27.1（26.3-27.9），此后，在第 3 年降至 9.5（8.9-10.1），在第 6 年降至 2.7（2.1-3.5）。在第 1、2、3、4、5 和 6 年时，保留在护理中的妇女比例分别为 78%、69%、63%、60%、57%和 56%。与 30-39 岁年龄组相比，年龄<20 岁的年轻女性（aHR 1.63，95%CI：1.38-1.92）和在妊娠第三个三个月而非第一个三个月登记的女性（aHR 1.29，95%CI：1.16-1.44）的 ART 中断率更高。相比之下，年龄≥40 岁的女性、在指数妊娠前开始接受 ART 的女性以及在高级别卫生机构就诊的女性的中断率较低。 结论：在垂直传播预防服务登记后的第一年，HIV 感染孕妇的 ART 中断率仍然最高，随后在向慢性 HIV 护理过渡后显著下降。在预防垂直传播期间和之后，针对 HIV 感染妇女的 ART 连续性进行有针对性的干预，对于结束儿童 HIV 感染和确保妇女和儿童的生存和健康至关重要。
BMC Pregnancy Childbirth. 2022-3-15
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