You are here
Disclosure and Knowledge Are Associated With Retention in Malawi's Option B+ Program
Risa M. Hoffman1; Khumbo Phiri2; Julie Parent2; Jonathan F. Grotts1; Sara Yeatman3; Paul Kawale2; David Elashoff1; Judith S. Currier4; Alan Schooley2
1Univ of California Los Angeles, Los Angeles, CA, USA;2Partners in Hope Med Cntr, Lilongwe, Malawi;3Univ of Colorado, Denver, CO, USA;4David Geffen Sch of Med at Univ of California Los Angeles, Los Angeles, CA, USA
There are limited data on factors associated with retention in Option B+. We sought to explore characteristics of women retained in Option B+ in Central Malawi, with a focus on the role of HIV disclosure, pre-ART education, and knowledge around the importance of Option B+ for maternal and child health.
We performed a case-control study of HIV-infected women in Malawi initiated on ART under Option B+. Cases were enrolled if they met criteria for default from Option B+ (out of ART for >60 days) and controls were enrolled in ~3:1 ratio if they were retained for at least 12 months. We surveyed sociodemographic characteristics, HIV disclosure (participant to partner and participant aware of partner status), self-report about receiving pre-ART education, and Option B+ knowledge using six questions. Univariate logistic regression was performed to determine factors associated with retention. A multiple logistic regression model was used to evaluate HIV disclosure and Option B+ knowledge while adjusting for age, schooling, and travel time to clinic.
We enrolled 50 cases and 153 controls. Median age was 30 years (IQR 25-34) and the majority (82%) initiated ART during pregnancy at a median gestational age of 24 weeks (IQR, 16-28). 91% of the cases (39/43) who started ART during pregnancy defaulted by 3 months postpartum. HIV disclosure to the primary sex partner was more common among women retained in care (100% versus 78%, p<0.001). Odds of retention were significantly higher among women with: age > 25 years (OR 2.44), completion of primary school (OR 3.06), awareness of partner HIV status (OR 5.20), pre-ART education (OR 6.17), higher number of correct answers to Option B+ knowledge questions (OR 1.82), and one or more methods of support while taking ART (OR 3.65) (Table). Pre-ART education and knowledge were significantly correlated (r = 0.43, p<0.001). Travel time of > 3 hours to clinic and later gestational age at ART initiation were associated with significantly reduced odds of retention (OR 0.13 and 0.95, respectively). In multivariate analysis, awareness of partner HIV status (OR 4.07, 95%CI 1.51, 10.94, p=0.02) and Option B+ knowledge (OR 1.60, 95%CI 1.15, 2.23, p=0.004) remained associated with retention.
Interventions that address partner disclosure and strengthen pre-ART education around the benefits of ART for maternal and child health should be evaluated as strategies to improve retention in Malawi’s Option B+ program.