ATTRITION OF WOMEN INITIATING ANTIRETROVIRAL THERAPY UNDER OPTION B+: COX PROPORTIONAL HAZARDS, COMPETING RISKS AND MULTISTATE SURVIVAL MODELS

Abstract

Prevention of Mother to Child Transmission (PMTCT) remains critical to de creasing the number of exposed children infected with HIV. However women need to remain on ART in order for PMTCT to be effective in preventing HIV trans mission. In 2011, the Malawi program changed the clinical guidelines for the provision of PMTCT to option B+. However, Option B+ intervention was implemented without any trials to assess effectiveness. To-date, few studies have evaluated outcomes of women on option B+. Therefore, knowledge on effective ness of option B+ is limited. This study explores the ART outcomes of women who initiated under option B+ in Malawi. This is in order to inform effective and efficient implementation of the interventions.This study explored facility level and individual level factors that affect attrition among Option B plus(Option B+) women in Malawi. Secondary data from PMTCT Retention of Option B+ Evaluation (PROBE) study collected by Management Sciences for Health (MSH) was used in the study. Three models of were used, Cox proportional hazards model, competing risks model and multi-state models. The main outcome variable was attrition from ART. The findings suggest that management authority, facility level, status at initiation, age group, ART education and clinical condition are significantly associated with attrition from ART. The association of the predictors and attrition, however, varies from ART registration to ART treatment follow-up and follow-up outcomes. On the other hand, location of residence did not have an effect on attrition from ART. The association of predictors and attrition however varies from ART registration to ART treatment follow-up and follow-up outcomes.