Early retention in antenatal care among HIV-positive women enrolled in the Option B+ program in Kinshasa, DRC
Background: Effective
retention in prevention of mother-to-child HIV prevention (PMTCT) programs
implementing universal, lifelong treatment (“Option B+”) is critical to
achieving pediatric HIV elimination. Innovative strategies are needed to strengthen
retention in PMTCT/antenatal care (ANC). The Elizabeth Glaser Pediatric AIDS
Foundation (EGPAF) assessed early loss to follow-up of HIV-positive pregnant
women in ANC following introduction of a standard operating procedure (SOP) in
select facilities in Kinshasa, Democratic Republic of the Congo. The SOP included
guidance to health providers and mentor mothers (HIV-positive expert patients)
on 1) linking newly and known HIV-positive women to these mothers, 2) counseling
at first ANC, 3) tracking those who miss antenatal appointments through phone
calls and home visits, and 4) documenting appointments and follow-up activities.
Methods: A
quasi-experimental study was conducted from May to November 2015 in 16 EGPAF-supported
health facilities, purposively selected for high volume and high HIV prevalence.
Facilities were randomized to receive the SOP enhancement or no intervention.
All records of HIV-positive women who attended their first ANC visit were
abstracted during the data collection period. Multiple logistic regressions were
used to identify determinants of second ANC visit attendance by HIV-positive
pregnant women enrolled in the PMTCT Option B+ program.
Results: One-hundred-and-seventy-four
women were included in the analysis: 43.7% (n=76) in the intervention and 56.3%
(n=96) in the comparison group. Women''s average age was 31 years (SD: 6.4). Approximately
86.2% of participants were assessed as WHO Clinical Stage I. Overall attrition
at the second ANC visit was 25.8% (n=45). After multivariable logistic
regression, being in the comparison group remained independently associated
with early attrition (AOR=3.49, CI 95%: 1.58-7.71, p=0.002). Women attending
facilities without SOP implementation were 3.5 times more likely to miss the
second ANC visit (n=35, 35.7%) compared to the women from the intervention
group (n=10, 13.2%).
Conclusions: Study findings demonstrated
a positive effect of the SOP intervention on second ANC visit attendance. This
SOP should be expanded to include the full range of ANC visits and delivery.
This tool should be promoted and scaled up to contribute to the improvement of
the retention in care for PMTCT clients.
J. Ditekemena Dinanga1, M.M. Gill2, A. Loando1, C. Nyombe3, J. Bakwalufu1, N. Mbonze1, F. Fwamba4, V. Ilunga1, R. Machekano2
1Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), MSA, Kinshasa, Congo, Democratic Republic of the, 2Elizabeth Glaser Pediatric AIDS Foundation - Global, Washington, United States, 3Kinshasa University School of Public Health, Kinshasa, Congo, Democratic Republic of the, 4Programme National de Lutte Contre le Sida, Kinshasa, Congo, Democratic Republic of the