Background: Malawi launched Option B+ in July 2011, a program for all pregnant or
breastfeeding HIV-positive women to begin lifelong combination antiretroviral therapy (cART).
This study characterizes the continuum of care within an antenatal setting in Lilongwe.
Methods: Women testing HIV-positive at Bwaila Antenatal Clinic from July 2013 to January
2014 were included. HIV testing and counseling logs were examined, and HIV-infected women
were linked to HIV mastercards and infant test records. Logistic regression models were used to
analyze relationships between characteristics recorded on the logs and maternal cART initiation,
retention, and return for infant testing.
Results: During this period, 578 women tested HIV-positive. Of these women, 490 (85%) were
linked to an ART initiation record; of these women, 398 (81%) had at least one follow-up record;
and of these women, 197 (49%) were retained with full adherence to antiretroviral therapy for
three months. Two hundred twenty (38%) were linked to a record of infant testing. Women
without an ART record (aOR = 0.19; 95% CI: 0.10, 0.35), women with no follow-up visits (aOR
= 0.20; 95% CI: 0.11, 0.36), and women not fully adherent for three months (aOR = 0.56; 95%
CI: 0.37, 0.84) were less likely to return for infant testing than women who were retained and
adherent for three months.
Discussion: Even with a test-and-treat program, many women did not initiate cART, remain in
care, or bring their infant for testing. Women lost are at highest risk for transmission and were
least likely to bring infants for testing. Facilitating care-seeking at all steps of the continuum
remains an important unmet need. Ensuring maternal health has the potential to make major
contributions towards maintaining environmental health, thus augmenting the importance of this
research.Bachelor of Science in Public Healt
