Low adherence to Option B+ antiretroviral therapy among pregnant women and lactating mothers in eastern Tanzania.

BackgroundAdherence to option B+ antiretroviral treatment (ART) is vital to a successful implementation of Prevention of Mother to Child Transmission (PMTCT) program. Further studies show that optimal viral suppression is also crucial for a successful PMTCT program, however barriers to adherence exist and differ among populations and particularly within few years of its adoption in Tanzania. This study therefore aimed at investigating the level and predictors of adherence to ART option B+ among pregnant and lactating women in rural and urban settings of eastern Tanzania.MethodologyA cross-sectional study was conducted among 305 pregnant women and lactating mothers on Option B+ regime from six health facilities located in rural and urban settings in Morogoro region in eastern Tanzania. Data were collected using a structured questionnaire. Data analysis was performed using descriptive statistics, as well as bivariate and multivariate logistic regression.ResultsGood adherence to option B+ PMTCT drugs was 26.3% and 61.1% among respondents residing in urban and rural areas respectively. The rural residents were 4.86 times more likely to adhere compared to their counterparts in an urban area (aOR = 4.86; 95% CI = 2.91-8.13). Similarly, women with male partners' support in PMTCT were 3.51 times more likely to have good adherence than those without (aOR = 3.51, 95% CI = 1.21-10.15). Moreover, there was a significantly lower odds of adherence to option B+ among those who had been on treatment between one to two years as compared to those had less than one year of treatment (aOR = 0.45; 95%CI = 0.22-0.93).ConclusionAdherence to PMTCT option B+ antiretroviral drugs treatment among pregnant women and breastfeeding mothers was low and much lower among urban residents. Adherence was significantly predicted by rural residence, male partner support and short duration on ART. Efforts to improve adherence should focus on increasing male participation on PMTCT, tailored interventions to urban residents and those who have been on ART for a long duration

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated