{
  "abstract": "Introduction Postpartum disengagement from HIV care increases risks for adverse maternal health outcomes and transmission of HIV through breastfeeding. In January 2015, South Africa implemented Option B+, a policy extending lifelong antiretroviral therapy (ART) eligibility to all pregnant women living with HIV (PWLWH) regardless of CD4 count. We assessed the impact of Option B+ on postpartum retention in HIV care for PWLWH and identified predictors of disengagement in the Option B+ era.Methods We linked maternal data from Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa, to HIV laboratory records from the National Health Laboratory Service. Using quasi-experimental designs (differences-in-differences; regression discontinuity), we estimated the causal effect of Option B+ on postpartum retention in HIV care, defined as any HIV-related laboratory test result 6–24 months after delivery. PWLWH with CD4>500 cells/µL were newly eligible for lifelong ART under Option B+ (‘treatment’ group); PWLWH with CD4≤350 cells/µL served as ‘controls’ as their eligibility for lifelong ART was unchanged by the policy. We also assessed predictors of postpartum disengagement from care in the Option B+ era using logistic regression models.Results We included 1684 women delivering from 1 July 2013 to 30 June 2016, of which 14% delivered in the pre-Option B+ period. Option B+ was associated with a 19 percentage point increase (95% CI 6% to 33%) in postpartum retention for the treatment group, relative to controls. We observed a 29 percentage point increase (95% CI 7% to 52%) in retention in the treatment group immediately after policy implementation. In the Option B+ era, PWLWH who initiated ART during pregnancy had 76% lower odds of postpartum retention than those who were already on ART before their pregnancy (OR: 0.24, 95% CI 0.18 to 0.32).Conclusion Option B+ improved postpartum retention among PWLWH newly eligible for lifelong ART. Still, women initiating ART during pregnancy exhibited significantly lower retention than those already on treatment, highlighting the need for further support to sustain care in this group.",
  "authors": [
    {
      "affiliations": [
        "Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa",
        "Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Evelyn Lauren"
    },
    {
      "affiliations": [
        "Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Johannesburg, South Africa"
      ],
      "name": "Karl-Günter Technau"
    },
    {
      "affiliations": [
        "School of Nursing, Vanderbilt University, Nashville, Tennessee, USA"
      ],
      "name": "Kate Clouse"
    },
    {
      "affiliations": [
        "Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Johannesburg, South Africa"
      ],
      "name": "Nicola van Dongen"
    },
    {
      "affiliations": [
        "Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Johannesburg, South Africa",
        "Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
      ],
      "name": "Amy Wise"
    },
    {
      "affiliations": [
        "Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Johannesburg, South Africa"
      ],
      "name": "Thalia Ferreira"
    },
    {
      "affiliations": [
        "Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
      ],
      "name": "Laura Rossouw"
    },
    {
      "affiliations": [
        "Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa",
        "Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA",
        "Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Jacob Bor"
    },
    {
      "affiliations": [
        "Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
      ],
      "name": "Mhairi Maskew"
    }
  ],
  "title": "Postpartum continuity of care for women with HIV: Option B+ policy impact and limitations in South Africa",
  "uid": "48791380-a1e9-5d52-be3c-8e97049b2be4"
}