Retention in care among HIV positive pregnant and breastfeeding women in a rural district in Zimbabwe: A dataset analysis

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DOI: 10.21522/TIJPH.2013.07.04.Art033

Authors : Addmore Chadambuka, Nicholas Midzi


Background: Studies have been done on retention in care for the general population but little is known of this phenomenon for HIV positive pregnant and breastfeeding women (PPBW). St Albert’s Mission Hospital data showed that 10% PPBW were lost to follow up. We determined retention in care in this population.

Methods: We conducted a cross sectional descriptive study using records of PPBW receiving care at the hospital from January 2016 to December 2018. We manually abstracted data from registers and from electronic records for analysis onto an Excel based abstraction sheet. We generated survival curves for the PPBW. We obtained waiver of informed consent for analysis of PPBW records.

Results: All pregnant women initiated in ART before ANC were retained up to between 25 and 30 months, where about 75% remained in care. Among those initiated during pregnancy, about 70% were no longer in care by 10 months of follow up. Retention rates were better for pregnant women initiated before ANC (p-value = 0.0272. log rank chi square test). Most breastfeeding women were still in care up to between 30 and 40 months for both who were initiated in pregnancy and before ANC for their current pregnancy. Thereafter a small drop in retention rates for those initiated on ART during pregnancy is noted (log rank chi square test p-value= 0.2183). Women initiated before ANC and those initiated during had generally the same retention rates.

Conclusion: Retention in care is high among PPBW but lower if ART initiation was due to the current pregnancy.

Keywords: retention in care, pregnant, breastfeeding, survival rate.


[1].      Baroncelli, S., Pirillo, M. F., Tamburrini, E., Guaraldi, G., Pinnetti, C., Degli Antoni, A., … Floridia, M. (2015). Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment. AIDS Research and Human Retroviruses, 31(7), 673–678.

[2].      Dzangare, J., Takarinda, K. C., Harries, A. D., Tayler-Smith, K., Mhangara, M., Apollo, T. M., … Mugurungi, O. (2016). HIV testing uptake and retention in care of HIV-infected pregnant and breastfeeding women initiated on ‘Option B+’ in rural Zimbabwe. Tropical Medicine & International Health, 21(2), 202–209.

[3].      Geng, E. H., Odeny, T. A., Lyamuya, R. E., Nakiwogga-Muwanga, A., Diero, L., Bwana, M., … Martin, J. N. (2015). Estimation of mortality among HIV-infected people on antiretroviral treatment in East Africa: A sampling-based approach in an observational, multisite, cohort study. The Lancet. HIV, 2(3), e107-116.

[4].      Kim, M., Zhou, A., Mazenga, A., Ahmed, S., Markham, C., & Zomba, G. (2016). Why did I stop? Barriers and facilitators to uptake and adherence to ART in option B+ HIV care in Lilongwe, Malawi. . . PLoS One, 11(2), e0149527.

[5].      Mangwiro, A.-Z., Makomva, K., Bhattacharya, A., Bhattacharya, G., Gotora, T., Owen, M., … Masuka, N. (2014). Does Provision of Point-of-Care CD4 Technology and Early Knowledge of CD4 Levels Affect Early Initiation and Retention on Antiretroviral Treatment in HIV-Positive Pregnant Women in the Context of Option B+ for PMTCT?: JAIDS Journal of Acquired Immune Deficiency Syndromes, 67, S139–S144.

[6].      Maskew, M., MacPhail, P., Menezes, C., & Rubel, D. (2007). Lost to follow up: Contributing factors and challenges in South African patients on antiretroviral therapy. South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, 97(9), 853–857.

[7].      McCoy, S. I., Njau, P. F., Fahey, C., Kapologwe, N., Kadiyala, S., Jewell, N. P., … Padian, N. S. (2017). Cash vs. Food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania. AIDS (London, England), 31(6), 815–825.

[8].      Ministry of Health and Child Care National Medicines and Therapeutics Policy Advisory Committee. (2016, December). Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe. Ministry of Health and Child Care, Zimbabwe.

[9].      Mitiku, I., Arefayne, M., Mesfin, Y., & Gizaw, M. (2016). Factors associated with loss to follow-up among women in Option B+ PMTCT programme in northeast Ethiopia: A retrospective cohort study. Journal of the International AIDS Society, 19(1), 20662.

[10].  MOH. (2015). Implementation of early retention monitoring of HIV positive pregnant and breastfeeding women and data use in the EMTCT program in Uganda. Ministry of Health, Uganda.

[11].  Muhumuza, S., Akello, E., Kyomugisha-Nuwagaba, C., Baryamutuma, R., Sebuliba, I., & Lutalo, I. (2017). Retention in care among HIV-infected pregnant and breastfeeding women on lifelong antiretroviral therapy in Uganda: A retrospective cohort study. PLoS ONE, 12(12), e0187605.

[12].  Namusobya, J., Semitala, F. C., Amanyire, G., Kabami, J., Chamie, G., Bogere, J., … Geng, E. H. (2013). High Retention in Care Among HIV-Infected Patients Entering Care with CD4 Levels >350 cells/μL Under Routine Program Conditions in Uganda. Clinical Infectious Diseases, 57(9), 1343–1350.

[13].  Rosen, S., Fox, M. P., & Gill, C. J. (2007). Patient retention in antiretroviral therapy programs in sub-Saharan Africa: A systematic review. PLoS Medicine, 4(10), e298.

[14].  Sanjobo, N., Frich, J. C., & Fretheim, A. (2008). Barriers and facilitators to patients’ adherence to antiretroviral treatment in Zambia: A qualitative study. SAHARA J: Journal of Social Aspects of HIV/AIDS Research Alliance, 5(3), 136–143.

[15].  Schouten, E. J., Jahn, A., Midiani, D., Makombe, S. D., Mnthambala, A., Chirwa, Z., … Chimbwandira, F. (2011). Prevention of mother-to-child transmission of HIV and the health-related Millennium Development Goals: Time for a public health approach. Lancet (London, England), 378(9787), 282–284.

[16].  Taha, T. E. (2011). Mother-to-child transmission of HIV-1 in sub-Saharan Africa: Past, present and future challenges. Life Sciences, 88(21–22), 917–921.

[17].  Tenthani, L, Haas, A., Tweya, H., Jahn, A., van Oosterhout, J., & Chimbwandira, F. (2014). Retention in care under universal antiretroviral therapy for HIV infected pregnant and breastfeeding women (“option B+”) in Malawi. AIDS, 28(4), 589.

[18].  Tenthani, Lyson, Haas, A. D., Tweya, H., Jahn, A., van Oosterhout, J. J., Chimbwandira, F., … Keiser, O. (2014). Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+’) in Malawi. AIDS (London, England), 28(4), 589–598.

[19].  Tweya, H., Gugsa, S., Hosseinipour, M., Speight, C., Ng’ambi, W., Bokosi, M., … Phiri, S. (2014). Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi. Tropical Medicine & International Health: TM & IH, 19(11), 1360–1366.

[20].  UAC. (2016). The HIV and AIDS Uganda Country Progress Report 2015–2016 (Health, Trans.): Uganda AIDS Commission (UAC) (pp. 1–73). Retrieved from,

[21].  UNAIDS. (2012). A Progress report on the global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Geneva: UNAIDS, WHO.

[22].  UNAIDS, 2014. (2014a). 2013 Progress report on the global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.

[23].  UNAIDS, 2014. (2014b). An ambitious treatment target to help end the AIDS epidemic. UNAIDS.

[24].  Weiser, S. D., Tuller, D. M., Frongillo, E. A., Senkungu, J., Mukiibi, N., & Bangsberg, D. R. (2010). Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda. PloS One, 5(4), e10340.