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

BACKGROUND: Life-long ART for pregnant and breastfeeding women (Option B+) was rolled-out in Zimbabwe from 2014 with simultaneous raising of the CD4 treatment-threshold in non-pregnant/breastfeeding adults and children >5 years to 500 cells/mm(3). METHODS: Lablite is an implementation project in Zimbabwe, Malawi and Uganda evaluating ART rollout. Routine patient-level data were collected for 6 months prior to and 12 months after Option B+ rollout at a district hospital and three primary care facilities in Zimbabwe (two with outreach ART; one with no ART provision prior to Option B+). RESULTS: Between September 2013-February 2015 there were 1,686 ART initiations in the four facilities; 91% adults and 9% children aged <15 years. In the three 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 WHO stage 3/4 or CD4≤350 (64% for CD4≤500). 74 (22%) men and 123 (34%) non-pregnant/breastfeeding women 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 following implementation of WHO 2013 guidelines. Retention of Option B+ women was poorer than retention of other adults; younger women require attention as they are more likely to disengage from care.