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Implementation of Antiretroviral Therapy for Life in Pregnant/Breastfeeding HIV+ Women (Option B+) Alongside Rollout and Changing Guidelines for ART Initiation in Rural Zimbabwe: The Lablite Project Experience

Ford, Deborah PhD; Muzambi, Margaret BSc; Nkhata, Misheck J. MSc; Abongomera, George MSc; Joseph, Sarah PhD; Ndlovu, Makosonke BSc; Mabugu, Travor MSc; Grundy, Caroline LLB; Chan, Adrienne K. MD; Cataldo, Fabian PhD; Kityo, Cissy MSc; Seeley, Janet PhD; Katabira, Elly FRCP; Gilks, Charles F. DPhil; Reid, Andrew MRCP; Hakim, James PhD; Gibb, Diana M. MDthe Lablite Team

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15th, 2017 - Volume 74 - Issue 5 - p 508–516
doi: 10.1097/QAI.0000000000001267
Implementation Science

Background: Lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (Option B+) was rolled out in Zimbabwe from 2014, with simultaneous raising of the CD4 treatment threshold to 500 cells per cubic millimeter in nonpregnant/breastfeeding adults and children 5 years and over.

Methods: Lablite is an implementation project in Zimbabwe, Malawi, and Uganda evaluating ART rollout. Routine patient-level data were collected for 6 months before and 12 months after Option B+ rollout at a district hospital and 3 primary care facilities in Zimbabwe (2 with outreach ART and 1 with no ART provision before Option B+).

Results: Between September 2013 and February 2015, there were 1686 ART initiations in the 4 facilities: 91% adults and 9% children younger than 15 years. In the 3 facilities with established ART, initiations rose from 300 during 6 months before Option B+ to 869 (2.9-fold) and 463 (1.5-fold), respectively, 0–6 months and 6–12 months after Option B+. Post-Option B+, an estimated 43% of pregnant/breastfeeding women needed ART for their own health, based on World Health Organization stage 3/4 or CD4 ≤350 per cubic millimeter (64% for CD4 ≤500). Seventy-four men (22%) and 123 nonpregnant/breastfeeding women (34%) initiated ART with CD4 >350 after the CD4 threshold increase. Estimated 12-month retention on ART was 79% (69%–87%) in Option B+ women (significantly lower in younger women, P = 0.01) versus 93% (91%–95%) in other adults (difference P < 0.001).

Conclusions: There were increased ART initiations in all patient groups after implementation of World Health Organization 2013 guidelines. Retention of Option B+ women was poorer than retention of other adults; younger women require attention because they are more likely to disengage from care.

*MRC Clinical Trials Unit at University College London, London, United Kingdom;

University of Zimbabwe, Harare, Zimbabwe;

Dignitas International, Zomba, Malawi;

§Joint Clinical Research Centre, Kampala, Uganda;

Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;

MRC/UVRI Uganda Research Unit of AIDS, Entebbe, Uganda;

#Infectious Diseases Institute, Makerere University, Mulago, Uganda; and

**School of Population Health, University of Queensland, Queensland, Australia.

Correspondence to: Deborah Ford, PhD, MRC Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London WC2B 6NH, United Kingdom (e-mail:

Supported by Department for International Development, United Kingdom.

Presented at International Conference on AIDS and STIs in Africa, November 30, 2015, Harare, Zimbabwe.

The authors have no conflicts of interest to disclose.

This article is an output from a project funded by DFID for the benefit of developing countries. The views expressed are not necessarily those of DFID.

D.F. and M.M. have contributed equally.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Received July 01, 2016

Accepted October 31, 2016

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