ART Attrition Across Health Facilities Implementing Option B+ in Haiti

J Int Assoc Provid AIDS Care. Jan-Dec 2018;17:2325958218774037. doi: 10.1177/2325958218774037.


Background: Describing factors related to high attrition is important in order to improve the implementation of the Option B+ strategy in Haiti.

Methods: We conducted a retrospective cohort study to describe the variability of antiretroviral therapy (ART) retention across health facilities among pregnant and lactating women and assess for differences in ART retention between Option B+ clients and other ART patients.

Results: There were 1989 Option B+ clients who initiated ART in 45 health facilities. The percentage of attrition varied from 9% to 81% across the facilities. The largest health facilities had 38% higher risk of attrition (relative risk [RR]: 1.38, 95% confidence interval [CI]: 1.08-1.77, P = .009). Private institutions had 18% less risk of attrition (RR: 0.82, 95% CI: 0.70-0.96, P = .020). Health facilities located in the West department and the South region had lower risk of attrition.

Conclusion: Being on treatment in a large or public health facility or a facility located in the North region was a significant risk factor associated with high attrition among Option B+ clients. The implementation of the Option B+ strategy must be reevaluated in order to effectively eliminate mother-to-child HIV transmission.

Keywords: ART attrition; Option B+; health facility–level risk factors.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active / statistics & numerical data*
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • HIV Infections / transmission*
  • Haiti / epidemiology
  • Health Facilities / statistics & numerical data*
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Lactation
  • Medication Adherence / statistics & numerical data*
  • Pregnancy
  • Retrospective Studies
  • Risk Factors
  • Young Adult