Background: In March 2013, Uganda adopted Option B+, providing lifelong antiretroviral therapy (ART) for all HIV+ pregnant women; however, only 40% of mother-infant pairs were retained in care by the end of the breastfeeding period. Retention must improve in order to achieve Uganda''s goal of eliminating mother-to-child-transmission. A pilot was conducted in 2014 to evaluate the effectiveness of a package of interventions consisting of phone and home-visit follow-ups, strengthening the use of appointment books to track attendance, and patient-held appointment calendars. The study''s objective was to determine if retention increased for both HIV+ pregnant/postnatal women and HIV-exposed infants.
Methods: A pre-post study was designed, selecting 20 rural facilities from six districts. Data were collected retrospectively for six months prior to and six months during the pilot period. Retention was defined as a woman or infant remaining in care for a minimum of five months after enrolment into the cohort, determined by the ART visit schedule. Retention rates were assessed by facility using weighted paired t-tests on cluster-level summaries.
Results: 686 women and 358 infants were included in the pre-pilot implementation period; 604 women and 332 infants during the pilot. Retention in care for mothers increased from 72.8% to 80.3% (p=0.009). This was driven by women who initiated on ART during pregnancy, as their retention rates increased from 68.5% to 76.0% (p=0.031). Women under 20 had almost three times more of an increase in retention compared to women of older ages. Retention for HIV-exposed infants increased from 41.3% to 61.1% (p=0.001). 30% of appointments were missed during the pilot program requiring follow-up, of those missed appointments, 28% received followed-up. There was a 70% return rate for missed appointments relative to a 12% return rate for appointments that received no follow-up.
Conclusions: The results of the pilot showed a significant impact on retention that will result in fewer HIV+ infants and better health outcomes for HIV+ mothers. Despite a low missed visit follow up rate, when conducted, the impact was substantial. In January 2016 Uganda adopted this model to be the national standard of care for follow-up of mother-infant pairs in all PMTCT sites nationwide.