Abstract

Introduction: Retention-in-care and adherence to lifelong antiretroviral therapy (ART) are major requirements to successfully optimise treatment benefits. We assessed linkage and retention-in-care with adherence and determinants of poor adherence along the PMTCT cascade in HIV-positive pregnant and breastfeeding women initiating option B+ in Cameroon. Materials and Methods: We prospectively determined uptake of HIV testing and counselling (HTC), uptake of ART, retention-in-care and adherence after Option B+ initiation between October 2013 and December 2014 in pregnant and breastfeeding women from five sites within the Kumba Health District. Retention-in-care was assessed over at least 12 months follow-up and estimated by Kaplan Meier analysis. Adherence at 12 months was determined for women retained in care using a composite adherence score. During follow-up, tracing outcomes and reasons for discontinuing treatment were documented and adherence measured. Results: Uptake of HTC in 5,813 women with unknown HIV status was 98.5% and ART uptake in women eligible to start Option B+ was 96.8%. We enrolled 268 women initiating lifelong ART in the follow up. Overall, 65 (24.3%) discontinued treatment, either defined by loss to follow-up 29(44.6%) or actively stopped treatment 36(55.8%). Retention-in-care was 88.0% and 81.1% at 6 and 12 months, respectively. Discontinuation was significantly associated in multivariate analysis with small sites and high staff turnover [aOR 2.5 (95% CI 1.6, 3.9), p < 0.001]. At 12 months 88.6% of women retained in care had good treatment adherence. After adjusting for confounders, younger age, attending a Pentecostal church, low level of education and employment in the informal sector significantly predicted poor adherence. Conclusion: Twelve months retention-in-care and adherence for women retained were 81.1% and 88.6% respectively. Retention-in-care was lowest at small facilities with a high staff turnover while adherence was poor for younger, women with low level of education, attending Pentecostal churches and employed in the informal sector.