A Novel Combined Mother-Infant Clinic to Optimize Post-Partum Maternal Retention, Service Utilization, and Linkage to Services in HIV Care in Rural Rwanda

Background and Objectives: Despite recent improvements in accessibility of services to prevent mother-to-child transmission of HIV, maternal retention in HIV care remains a challenge in the postpartum period. This study assessed service utilization, program retention, and linkage to routine services, as well as clinical outcomes for mothers and infants, following implementation of an integrated mother-infant clinic in rural Rwanda.Methods: We conducted a retrospective cohort study of all HIV-positive mothers and their infants enrolled in the integrated clinics in two rural districts between July 1, 2012, and June 30, 2013. At 18 months post-partum, data on mother-infant service utilization and program outcomes were reported.Results: Of the 185 mother-infant pairs in the clinics, 98.4% of mothers were on antiretroviral therapy (ART) and 30.3% used modern contraception at enrollment. At 18 months post-partum, 98.4% of mothers were retained and linked back to adult HIV program. All mothers were on ART and 72.0% on modern contraception. For infants, 93.0% completed follow-up. Two (1.1%) infants tested HIV positive.Conclusion and Global Health Implication: An integrated clinic was successfully implemented in rural Rwanda with high mother retention in care and low mother to child HIV transmission rates. This model of integration of services may contribute to improved mother-infant retention in care during post-partum period and should be considered as one approach to addressing this challenge in similar settings.Key words: HIV • Integrated Clinic • Combined Clinic • Antiretroviral Therapy • Post-partum Retention • Linkages • ART • PMTCT • Option B+ • AfricaCopyright © 2017 Neza Guillaine et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.affect economic and health promotion.

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Why do patients interrupt and return to antiretroviral therapy? Retention in HIV care from the patient’s perspective in Johannesburg, South Africa

PLoS ONE ◽

10.1371/journal.pone.0256540 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0256540

Author(s):

Melanie A. Bisnauth ◽

Natasha Davies ◽

Sibongile Monareng ◽

Fezile Buthelezi ◽

Helen Struthers ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Health Services ◽

Healthcare Providers ◽

Retention In Care ◽

Hiv Care ◽

People Living With Hiv ◽

Structured Interviews ◽

Related Factors ◽

Retention In Hiv Care

Background Retention in care is required for optimal clinical outcomes in people living with HIV (PLHIV). Although most PLHIV in South Africa know their HIV status, only 70% are on antiretroviral therapy (ART). Improved retention in care is needed to get closer to sustained ART for all. In January 2019, Anova Health Institute conducted a campaign to encourage patients who had interrupted ART to return to care. Methods Data collection was conducted in one region of Johannesburg. This mixed methods study consisted of two components: 1) healthcare providers entered data into a structured tool for all patients re-initiating ART at nine clinics over a nine-month period, 2) Semi-structured interviews were conducted with a sub-set of patients. Responses to the tool were analysed descriptively, we report frequencies, and percentages. A thematic approach was used to analyse participant experiences in-depth. Results 562 people re-initiated ART, 66% were women, 75% were 25–49 years old. The three most common reasons for disengagement from care were mobility (30%), ART related factors (15%), and time limitations due to work (10%). Reasons for returning included it becoming easier to attend the clinic (34%) and worry about not being on ART (19%). Mobile interview participants often forgot their medical files and expressed that managing their ART was difficult because they often needed a transfer letter to gain access to ART at another facility. On the other hand, clinics that had flexible and extended hours facilitated retention in care. Conclusion In both the quantitative data, and the qualitative analysis, changing life circumstances was the most prominent reason for disengagement from care. Health services were not perceived to be responsive to life changes or mobility, leading to disengagement. More client-centred and responsive health services should improve retention on ART.

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Fundamentals of HIV Medicine 2017

10.1093/med/9780190493097.001.0001 ◽

2017 ◽

Author(s):

American Academy of HIV Medicine

Keyword(s):

Antiretroviral Therapy ◽

Hiv Transmission ◽

Retention In Care ◽

Hiv Care ◽

Coordination Of Care ◽

Accountable Care ◽

Care Providers ◽

Prevention Strategies ◽

Economic Issues ◽

Transmission Prevention

Fundamentals of HIV Medicine is the nation’s most frequently utilized HIV patient care and reference textbook. Authored by leading HIV care providers, researchers, and experts, the new 2017 edition provides a comprehensive review of all facets of the medical management of individuals with HIV. The following topics are discussed in the book: epidemiology and the spread of HIV, mechanisms of HIV transmission, transmission prevention strategies, immunology, HIV elimination strategies, linkage into care, retention in care and accountable care, complementary and alternative medicine approaches, coordination of care, antiretroviral therapy, antiretroviral therapy in special populations, comorbidities and complications, social and economic issues, and clinical research.

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1042. The Attitude of Patients With HIV about Telehealth for Their HIV Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1228 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S550-S551

Author(s):

Dima Dandachi ◽

Bich Dang ◽

Thomas Giordano Giordano

Keyword(s):

Hiv Transmission ◽

Personal Information ◽

Critical Role ◽

Retention In Care ◽

Hiv Care ◽

Structural Factors ◽

Personal Factors ◽

Response Distribution ◽

Related Factors ◽

Clinic Visits

Abstract Background The world is facing a pandemic of SARS-CoV-2 that disrupted our healthcare system and the way we deliver healthcare. For people with HIV (PWH), the ability to be retained in care plays a critical role in improving health outcomes and in preventing HIV transmission. Several definitions exist for retention in care, but they are centered around outpatient clinic visits. It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to face clinic visits. Methods We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February–June 2018. The survey items were used to assess PWH’s attitudes towards and concerns for telehealth and explanatory variables. Results 371 participants completed the survey; median age was 51, 36% were female, and 63% African-American. Overall, 57% of respondents were more likely to use telehealth for their HIV care if available, as compared to one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits. Participants reported many benefits including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth. Survey items and response distribution Conclusion Telehealth programs for PWH can improve retention in care. A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH. Disclosures All Authors: No reported disclosures

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Increasing Access and Adherence to the PMTCT Cascade: Is There a Role for Economic Strengthening Interventions?

International Journal of Population Research ◽

10.1155/2016/4039012 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Irina Yacobson ◽

Morrisa Malkin ◽

Elena Lebetkin

Keyword(s):

Pregnant Women ◽

Hiv Transmission ◽

Randomised Trial ◽

Retention In Care ◽

Economic Barriers ◽

Research Questions ◽

Women With Hiv ◽

Mother To Child ◽

Economic Strengthening ◽

Pmtct Cascade

Interventions aimed at prevention of mother-to-child transmission (PMTCT) of HIV are extremely effective but remain underutilized in many countries. Common economic barriers to PMTCT experienced by pregnant women with HIV are well documented. Addressing these economic barriers has a potential to improve PMTCT utilization and further reduce mother-to-child HIV transmission. This review examines the evidence of the effects economic strengthening (ES) interventions have on use of and adherence to PMTCT and other health services relevant to PMTCT cascade. While very few studies on ES interventions were conducted in PMTCT settings, the results of a recent randomised trial demonstrate that conditional cash transfers offered to women in PMTCT programme can significantly improve retention in care and adherence to treatment. This review also considers evidence on ES interventions conducted within other health care settings relevant to PMTCT cascade. While the evidence from other settings is promising, it may not be fully applicable to PMTCT and more quality research on ES interventions among population of pregnant women with HIV is needed. Answering some of the research questions formulated by this review can provide more evidence for programme implementers and guide decisions about how to increase women’s use of and adherence to PMTCT services.

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Applying Quality Improvement Approaches to Reduce Mother-to-Child HIV Transmission and Improve Health and Nutrition Care in Five Countries: Lessons from the Partnership for HIV-Free Survival

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219847458 ◽

2019 ◽

Vol 18 ◽

pp. 232595821984745

Author(s):

Amy F. Stern ◽

Anisa Ismail ◽

Esther Karamagi ◽

Tamara Nsubuga-Nyombi ◽

Stella Kasindi Mwita ◽

...

Keyword(s):

Quality Improvement ◽

Hiv Transmission ◽

Retention In Care ◽

Complex Problem ◽

World Health ◽

Free Survival ◽

Hiv Positive Women ◽

Vertical Transmission Of Hiv ◽

Health Organization ◽

Mother To Child

The World Health Organization guidelines for treating pregnant HIV-positive women and preventing HIV transmission to infants now recommend lifelong antiretroviral treatment for pregnant and breastfeeding women. We applied quality improvement (QI) methods to support governments and facility staff to address service gaps in 5 countries under the Partnership for HIV-Free Survival (PHFS). We used 3 key strategies: break the complex problem of improving HIV-free survival into more easily implementable phases, support a national management team to oversee the project, and support facility-level staff to learn and apply QI methods to reducing mother-to-child transmission. The key results in each country were increases in data completeness and accuracy, increases in retention in care of mother–baby pairs (MBPs), increase in coverage of MBPs with appropriate services, and reduction in vertical transmission of HIV. The PHFS experience offers a model that other multicountry networks can adopt to improve service delivery and quality of care.

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Integrated prevention of mother-to-child HIV transmission services, antiretroviral therapy initiation, and maternal and infant retention in care in rural north-central Nigeria: a cluster-randomised controlled trial

The Lancet HIV ◽

10.1016/s2352-3018(16)00018-7 ◽

2016 ◽

Vol 3 (5) ◽

pp. e202-e211 ◽

Cited By ~ 45

Author(s):

Muktar H Aliyu ◽

Meridith Blevins ◽

Carolyn M Audet ◽

Marcia Kalish ◽

Usman I Gebi ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Hiv Transmission ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Retention In Care ◽

North Central ◽

Therapy Initiation ◽

Cluster Randomised ◽

Randomised Controlled ◽

Mother To Child

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Triple Antiretroviral Therapy Effectively Eliminates HIV Transmission from Mother to Child

THE ULUTAS MEDICAL JOURNAL ◽

10.5455/umj.20161215092116 ◽

2016 ◽

Vol 2 (4) ◽

pp. 176

Author(s):

Sarma Lumbanraja

Keyword(s):

Antiretroviral Therapy ◽

Hiv Transmission ◽

Mother To Child

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Factors associated with non-retention in HIV care in an era of widespread antiretroviral therapy

International Journal of STD & AIDS ◽

10.1177/0956462416663868 ◽

2016 ◽

Vol 28 (7) ◽

pp. 679-684 ◽

Cited By ~ 1

Author(s):

Sarah O’Connell ◽

Anna O’Rourke ◽

Eileen Sweeney ◽

Almida Lynam ◽

Corinna Sadlier ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Drug Users ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Structured Interview ◽

Hiv Care ◽

Factors Associated ◽

Retention In Hiv Care ◽

Sex With Men ◽

Hiv 1

In an era of antiretroviral therapy (ART) for all HIV-1-infected patients, our primary aim was to describe prevalence and characteristics of patients disengaged from care at an urban ambulatory HIV clinic. We conducted a nested case–control study. All patients who disengaged from care (defined as being lost to follow-up for at least one year) from 2007 to 2014 inclusive were identified. Cases were matched to controls in a 1:4 ratio. A total of 1250 cases were included; 250/2289 (10.9%) of patients attending our HIV clinic disengaged from 2007 to 2014. One hundred and twenty-six (50.4%) were heterosexual, 81 (32.4%) were men who have sex with men and 40 (16%) were intravenous drug users. On univariate analysis only, patients with heterosexual risk were more likely to disengage from care (50.4% vs. 33.7%, p: <0.001). Those who disengaged were younger, mean age of 39 (p: <0.001). A higher proportion of patients who disengaged from care was not receiving ART and did not have a suppressed HIV-1 viral load (p: <0.001). On multivariable analysis, Irish patients were less likely to disengage from HIV care (odds ratio: 0.567, p: 0.002). Factors associated with non-retention in HIV care have been identified. A semi-structured interview of those patients who re-engaged will take place to further examine reasons for disengagement from care.

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