Browsing by Author "Wools-Kaloustian KK"

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    Increased prevalence of pregnancy and comparative risk of program attrition among individuals starting HIV treatment in East Africa.
    (2018) Holmes CB; Yiannoutsos CT; Elul B; Bukusi E; Ssali J; Kambugu A; Musick BS; Cohen C; Williams C; Diero L; Padian N; Wools-Kaloustian KK; Masaka Regional Hospital, Masaka, Uganda.; National Institute of Allergies and Infectious Diseases, Bethesda, Maryland, United States of America.; Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; University of California San Francisco, San Francisco, California, United States of America.; University of California, Berkeley, California, United States of America.; Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya.; Georgetown University School of Medicine, Washington, DC, United States of America.; Indiana University School of Medicine, Indianapolis, Indiana, United States of America.; Mailman School of Public Health, Columbia University, ICAP at Columbia University, New York, New York, United States of America.; Infectious Diseases Institute, Kampala, Uganda.; Indiana University R.M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: The World Health Organization now recommends initiating all pregnant women on life-long antiretroviral therapy (ART), yet there is limited information about the characteristics and program outcomes of pregnant women already on ART in Africa. Our hypothesis was that pregnant women comprised an increasing proportion of those starting ART, and that sub-groups of these women were at higher risk for program attrition. METHODS AND FINDINGS: We used the International Epidemiology Databases to Evaluate AIDS- East Africa (IeDEA-EA) to conduct a retrospective cohort study including HIV care and treatment programs in Kenya, Uganda, and Tanzania. The cohort consecutively included HIV-infected individuals 13 years or older starting ART 2004-2014. We examined trends over time in the proportion pregnant, their characteristics and program attrition rates compared to others initiating and already receiving ART. 156,474 HIV-infected individuals (67.0% women) started ART. The proportion of individuals starting ART who were pregnant women rose from 5.3% in 2004 to 12.2% in 2014. Mean CD4 cell counts at ART initiation, weighted for annual program size, increased from 2004 to 2014, led by non-pregnant women (annual increase 20 cells/mm3) and men (17 cells/mm3 annually), with lower rates of change in pregnant women (10 cells/mm3 per year) (p<0.0001). There was no significant difference in the cumulative incidence of program attrition at 6 months among pregnant women starting ART and non-pregnant women. However, healthy pregnant women starting ART (WHO stage 1/2) had a higher rate of attrition rate (9.6%), compared with healthy non-pregnant women (6.5%); in contrast among women with WHO stage 3/4 disease, pregnant women had lower attrition (8.4%) than non-pregnant women (14.4%). Among women who initiated ART when healthy and remained in care for six months, subsequent six-month attrition was slightly higher among pregnant women at ART start (3.5%) compared to those who were not pregnant (2.4%), (absolute difference 1.1%, 95% CI 0.7%-1.5%). CONCLUSIONS: Pregnant women comprise an increasing proportion of those initiating ART in Africa, and pregnant women starting ART while healthy are at higher risk for program attrition than non-pregnant women. As ART programs further expand access to healthier pregnant women, further studies are needed to better understand the drivers of loss among this high risk group of women to optimize retention.