Promising adherence results in the context of lifelong ART implementation in the Kabeho study in Kigali, Rwanda
Background: In April 2012, Rwanda implemented a policy to initiate all HIV-positive pregnant women on lifelong antiretroviral treatment (ART) (''Option B+''). Lessons learned from the Rwanda program will inform other countries transitioning to Option B+ following the 2013 WHO consolidated guidelines. In April 2013, EGPAF and the Ministry of Health initiated the Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (the Kabeho Study). The study, supported by the President''s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID), will determine the 18-month HIV-free survival of a cohort of HIV-exposed children in the PMTCT program.
Methods: From April 2013-January 2014, 608 HIV-positive women in their third trimester of pregnancy or within the first two weeks of delivery were enrolled in the observational prospective cohort from 14 health facilities in Kigali. After providing written informed consent, women underwent an enrollment interview, which included HIV and ART-related history and adherence, and had blood drawn for viral load (VL) testing by RNA-PCR.
Results: Women had a median age of 29 (IQR 25-34) and the majority (79%, N=479) were married or co-habitating. The median time women knew their HIV-positive status was 38.5 months (IQR 4.75 - 84.4). Most women (81.6%, N=494) had disclosed to their partner; half reported that the father of the baby was also HIV-positive (50.3%, N=304). The most common ARV regimen (56.6%, N=342) was TDF/3TC/EFV. Overall 35.3% (N=214) of women reported taking another ARV regimen previously, frequently (21.5%, N=130) due to PMTCT during an earlier pregnancy, consistent with national policy. At the time of study enrollment, women were on ART for a median of 13.2 months (IQR 2.9 - 49.5) with the median length of time on her current ART combination of 7.6 months (IQR 2.3-34.5). The reported adherence rate based on a 3-day ART recall was 95.6%. Of the 540 women with an enrollment viral load available, over half (53.1%) had undetectable VL and 84.3% had VL < 1,000 copies/ml.
Conclusions: High rates of uptake and adherence to ART can be achieved with the implementation of Option B+, particularly in a setting with high rates of partner disclosure.
E.A. Bobrow1, P. Mugwaneza2, G.F. Ndayisaba3, D. Ndatimana3, M. Gill1, H.J. Hoffman4, J.C. Uwimbabazi2, C. Baribwira5, E. Remera2, L. Guay1,4, A. Asiimwe2, Kabeho Study Team
1Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Washington DC, United States, 2Ministry of Health, Kigali, Rwanda, 3Elizabeth Glaser Pediatric AIDS Foundation, Kigali, Rwanda, 4George Washington University School of Public Health and Health Services, Washington DC, United States, 5University of Maryland, School of Medicine, Kigali, Rwanda