1*Applied Analytics Team, Clinton Health Access Initiative, Lusaka, Zambia; †Applied Analytics Team, Clinton Health Access Initiative, Boston, MA; ‡Ministry of Health and Child Care, Mutare, Zimbabwe; §Family AIDS Caring Trust, Mutare, Zimbabwe; ‖Clinton Health Access Initiative, Harare, Zimbabwe; ¶Department of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi; #Centre for Integrated Health Programs, Abuja, Nigeria; **Lighthouse Trust, Lilongwe, Malawi; ††Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; ‡‡Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Lilongwe, Malawi; §§International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria; ‖‖Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD; and ¶¶World Health Organization, Geneva, Switzerland.
BACKGROUND:: Six implementation research studies in Malawi, Nigeria, and Zimbabwe tested approaches for improving retention in care among women living with HIV. We simulated the impact of their interventions on the probability of HIV transmission during pregnancy and breastfeeding. METHODS:: A computer-based state-transition model was developed to estimate the impact of the retention interventions. Patient-level data from the 6 studies were aggregated and analyzed, and weighted averages of mother-to-child transmission (MTCT) of HIV probabilities were presented. The average MTCT probability of the more successful interventions was applied to national estimates to calculate potential infections averted if these interventions were taken to scale. RESULTS:: Among the total cohort of 5742... HIV-positive women, almost 80% of all infant infections are attributed to the roughly 20% of HIV-positive pregnant and breastfeeding women not retained on antiretroviral therapy. Higher retention in the arms receiving interventions resulted in an overall lower estimated MTCT probability of 9.9% compared with 12.3% in the control arms. In the 2 studies that showed a statistically significant effect, Prevention of MTCT Uptake and Retention (PURE) and Mother Mentor (MoMent), the difference in transmission rates between intervention and control arms was 4.1% and 7.3%, respectively. Scaling up retention interventions nationally in the 3 countries could avert an average of almost 3000 infant infections annually. CONCLUSIONS:: Linking HIV-positive pregnant women to antiretroviral therapy and retaining them is essential for addressing the remaining gaps and challenges in HIV/AIDS care and the elimination of MTCT. At national level, even modest improvements in retention translates into large numbers of infant infections averted.