Retention in HIV care during pregnancy and the postpartum period in the option B+ era: A systematic review and meta-analysis of studies in Africa

BACKGROUND: Under Option B+ guidelines for prevention of mother-to-child transmission of HIV (PMTCT), pregnant and breastfeeding women initiate antiretroviral therapy (ART) for lifelong use. The objectives of this study were: 1) to synthesize data on retention in care over time in Option B+ programs in Africa, and 2) to identify factors associated with retention in care. METHODS: PubMed, EMBASE, and African Index Medicus were systematically searched from January 2012 to June 2017. Pooled estimates of the proportion of women retained were generated; factors associated with retention were analyzed thematically. RESULTS: 35 articles were included in the final review; 22 reported retention rates (n=60,890) and 25 reported factors associated with retention. Pooled estimates of retention were 72.9% (95% CI: 66.4%, 78.9%) at 6 months for studies reporting <12 months of follow up and 76.4% (95% CI: 69.0%, 83.1%) at 12 months for studies reporting >/=12 months of follow up. Data on undocumented clinic transfers were largely absent. Risk factors for poor retention included younger age, initiating ART on the same day as diagnosis, initiating during pregnancy versus breastfeeding, and initiating late in the pregnancy. Retention was compromised by stigma, fear of disclosure, and lack of social support. CONCLUSIONS: Retention rates in PMTCT under Option B+ were below those of the general adult population, necessitating interventions targeting the complex circumstances of women initiating care under Option B+. Improved and standardized procedures to track and report retention are needed to accurately represent care engagement and capture undocumented transfers within the health system

• Determinants of Health
  • Social support
  • Stigma/discrimination
• Population(s)
  • Women
  • General HIV+ population
• Engagement and Care Cascade
  • Retention in care
  • Treatment
• Prevention
  • Biomedical interventions