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ART attrition and risk factors among Option B+ patients in Haiti: A retrospective cohort study.

ART attrition and risk factors among Option B+ patients in Haiti: A retrospective cohort study.
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Puttkammer N, Domerçant JW, Adler M, Yuhas K, Myrtil M, Young P, François K, Grand'Pierre R, Lowrance D,


Puttkammer N, Domerçant JW, Adler M, Yuhas K, Myrtil M, Young P, François K, Grand'Pierre R, Lowrance D, (click to view)

Puttkammer N, Domerçant JW, Adler M, Yuhas K, Myrtil M, Young P, François K, Grand'Pierre R, Lowrance D,

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PloS one 2017 03 0612(3) e0173123 doi 10.1371/journal.pone.0173123

Abstract
OBJECTIVES
In October 2012, the Haitian Ministry of Health endorsed the "Option B+" strategy to eliminate mother-to-child transmission of HIV and achieve HIV epidemic control. The objective of this paper is to assess and identify risk factors for attrition from the national ART program among Option B+ patients in the 12 months after ART initiation.

DESIGN
This retrospective cohort study included patients newly initiating ART from October 2012-August 2013 at 68 ART sites covering 45% of all newly enrolled ART patients in all regions of Haiti.

METHODS
With data from electronic medical records, we carried out descriptive analysis of sociodemographic, clinical, and pregnancy-related correlates of ART attrition, and used a modified Poisson regression approach to estimate relative risks in a multivariable model.

RESULTS
There were 2,166 Option B+ patients who initiated ART, of whom 1,023 were not retained by 12 months (47.2%). One quarter (25.3%) dropped out within 3 months of ART initiation. Protective factors included older age, more advanced HIV disease progression, and any adherence counseling prior to ART initiation, while risk factors included starting ART late in gestation, starting ART within 7 days of HIV testing, and using an atypical ART regimen.

DISCUSSION
Our study demonstrates early ART attrition among Option B+ patients and contributes evidence on the characteristics of women who are most at risk of attrition in Haiti. Our findings highlight the importance of targeted strategies to support retention among Option B+ patients.

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