Impact of Point-of-Care CD4 Testing on Retention in Care Among HIV-Positive Pregnant and Breastfeeding Women in the Context of Option B+ in Zimbabwe: A Cluster Randomized Controlled Trial

Journal of Acquired Immune Deficiency Syndromes : JAIDS
Jessica JosephAlexio-Zambezi Mangwiro

Abstract

Scale-up of Option B+ in Zimbabwe has increased antiretroviral therapy (ART) coverage but patient loss-to-follow-up remains high; thus, effective strategies to improve retention in care are needed. Evidence for Elimination, a cluster randomized controlled trial, evaluated the impact of point-of-care (POC) CD4 testing with CD4 count-specific adherence counseling on rates of retention among 1150 HIV-positive pregnant women initiating ART in Zimbabwe. Thirty-two primary care health facilities were randomized to offer either standard-of-care (SOC) or POC CD4 testing plus CD4-specific counseling to clients (POC Plus). The primary outcome was the proportion of HIV-positive pregnant women retained on ART after 12 months, calculated by cluster-adjusted proportions, unadjusted and adjusted relative risks (RR and aRR, respectively). Retention in care 12 months after initiation was 50.7% and 54.5% in the POC Plus and SOC arms, respectively (RR 0.93, 95% confidence interval [CI]: 0.78 to 1.11; aRR 0.91, 95% CI: 0.77 to 1.07). Although considered not retained, 9.7% transferred to another facility and 0.2% died. Most women, 95.3% in POC Plus and 92.9% in SOC, initiated ART within 1 month of antenatal booking (RR 1.03, 95% CI: 0.97 to 1.08). ...Continue Reading

References

Sep 7, 2012·BMJ : British Medical Journal·Marion K CampbellUNKNOWN CONSORT Group
Sep 27, 2012·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Kate ClouseMatthew P Fox
Jan 23, 2014·Journal of the International AIDS Society·Elke WynbergNathan Ford
Jan 29, 2014·AIDS·Lyson TenthaniUNKNOWN Ministry of Health in Malawi and IeDEA Southern Africa
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Nov 12, 2015·Tropical Medicine & International Health : TM & IH·Janet DzangareOwen Mugurungi

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Citations

May 13, 2017·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Nigel C RollinsGottfried O Hirnschall
Dec 30, 2017·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Brandon A KnettelMelissa H Watt
Feb 16, 2019·BMC Health Services Research·Fiona ScorgieMatthew F Chersich
Oct 9, 2020·Journal of the International AIDS Society·Helene FontUNKNOWN INSPIRE group

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