Retention-in-care from delivery through 18 months postpartum among HIV-positive mothers receiving lifelong ART in Kigali, Rwanda
Background: The Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) Study is an observational prospective cohort evaluation of the PMTCT program in Kigali following Option B+ implementation. Maternal retention-in-care from delivery (n=601) through 18-months postpartum was assessed.
Methods: Mothers enrolled from third trimester of pregnancy until two weeks postpartum from 14 high-volume sites were scheduled to attend monthly study visits, aligned with their routine PMTCT clinic visits. Health facilities conducted tracing within two weeks after missed clinic visits. If a mother did not attend a study visit within one week before or three weeks after the scheduled appointment, it was considered a missed study visit. Full retention was defined as attendance at 70-100% of scheduled visits, partial retention was 30-69.9%, and not retained in care was less than 30% of scheduled visits, excluding deaths.
Results: Between May 2013 and November 2015, PMTCT attendance was tracked with highest attendance at 6 weeks (88.7%), 9 months (81.4%) and 18 months (82.3%), corresponding to testing time points for HIV-exposed children. 80% of samples for early infant diagnosis were collected by 14 weeks. Thirty-four (5.8%) mothers terminated their infant''s involvement; reasons included 26 relocations, 5 consent withdrawals, 3 other reasons, although women may have continued to attend PMTCT. Of the 601 women who gave birth to 608 infants, there were 32 infant deaths, with 18 of those deaths and one withdrawal before the 6-week visit.
A total of 458 (80%) women were fully retained at 18 months postpartum, 91 (15.7%) were partially retained and 31 (5.3%) were not retained in care. Overall, 121 (20%) women missed three consecutive visits throughout the study.
Conclusions: Retention-in-care was high, yet missed visits and thus, ART interruption remains an issue even in an urban area with easier access to facilities. Highest attendance was at testing times for HIV-exposed children. 
[Figure 1. PMTCT attendance from delivery through 18 months postpartum among Kabeho Study participants receiving lifelong ART]
D. Ndatimana1, G. Ndayisaba1, E. Bobrow2, M. Gill2, L. Adair3, L. Guay2,4, P. Mugwaneza5, A. Asiimwe6, Kabeho Study Team
1Elizabeth Glaser Paediatric AIDS Foundation, Kigali, Rwanda, 2Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, United States, 3University of North Carolina, Chapel Hill, United States, 4George Washington University, Milken Institute School of Public Health, Washington DC, United States, 5Rwanda Ministry of Health, Kigali, Rwanda, 6Rwanda University Teaching Hospitals, Kigali, Rwanda