Miller, Kathleen2019-12-052018-052019-03-272018Miller, Kathleen. 2018. Program Implementation of Option B+ at a PEPFAR-Supported HIV Clinic Improves Clinical Indicators but Not Retention in Care in Mbarara, Uganda. Doctoral dissertation, Harvard Medical School.http://nrs.harvard.edu/urn-3:HUL.InstRepos:419734722013 WHO guidelines for prevention of mother to child transmission (PMTCT) recommend combination antiretroviral therapy (ART) for all pregnant women, regardless of CD4 count (Option B/B+). We conducted a retrospective analysis of data from a government-operated HIV clinic in Mbarara, Uganda before and after implementation of Option B+ to assess the impact on retention in care. We limited our analysis to women not on ART at the time of their first reported pregnancy with CD4 count > 350. We fit regression models to estimate relationships between calendar period (Option A versus Option B+) and the primary outcome of interest, retention in care. 1,062 women were included in the analysis. Women were more likely to start ART within 6 months of pregnancy in the Option B+ period (68% versus 7%, P<.0001) and had significantly greater increases in CD4 count one year after pregnancy (+172 versus -5 cells, P<0.001). However, there was no difference in the proportion of women retained in care 1 year after pregnancy (73% vs 70%, P=0.34). In models adjusted for age, distance to clinic, marital status and CD4 count, Option B+ was associated with a non-significant 30% increased odds of retention in care at 1 year (AOR = 1.30, 95% CI 0.98 – 1.73, P=0.06). After transition to an Option B+ program, pregnant women with CD4 count > 350 were more likely to initiate combination therapy; however, interventions to mitigate losses from HIV care during pregnancy are needed to improve the health of women, children and families.application/pdfenRetention in carePMTCTHIVThesis or Dissertation2019-12-05