Tenthani, LysonLysonTenthaniHaas, AndreasAndreasHaas0000-0002-4849-181XTweya, HannockHannockTweyaJahn, AndreasAndreasJahnvan Oosterhout, Joep J.Joep J.van OosterhoutChimbwandira, FrankFrankChimbwandiraChirwa, ZenganiZenganiChirwaNg'ambi, WingstonWingstonNg'ambiBakali, AlanAlanBakaliPhiri, SamSamPhiriMyer, LandonLandonMyerValeri, FabioFabioValeriZwahlen, MarcelMarcelZwahlen0000-0002-6772-6346Wandeler, GillesGillesWandelerKeiser, OliviaOliviaKeiser0000-0001-8191-27892024-10-142024-10-142014-02-20https://boris-portal.unibe.ch/handle/20.500.12422/113331OBJECTIVE To explore the levels and determinants of loss to follow-up (LTF) under universal lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') in Malawi. DESIGN, SETTING, AND PARTICIPANTS We examined retention in care, from the date of ART initiation up to 6 months, for women in the Option B+ program. We analysed nationwide facility-level data on women who started ART at 540 facilities (n = 21 939), as well as individual-level data on patients who started ART at 19 large facilities (n = 11 534). RESULTS Of the women who started ART under Option B+ (n = 21 939), 17% appeared to be lost to follow-up 6 months after ART initiation. Most losses occurred in the first 3 months of therapy. Option B+ patients who started therapy during pregnancy were five times more likely than women who started ART in WHO stage 3/4 or with a CD4 cell count 350 cells/μl or less, to never return after their initial clinic visit [odds ratio (OR) 5.0, 95% confidence interval (CI) 4.2-6.1]. Option B+ patients who started therapy while breastfeeding were twice as likely to miss their first follow-up visit (OR 2.2, 95% CI 1.8-2.8). LTF was highest in pregnant Option B+ patients who began ART at large clinics on the day they were diagnosed with HIV. LTF varied considerably between facilities, ranging from 0 to 58%. CONCLUSION Decreasing LTF will improve the effectiveness of the Option B+ approach. Tailored interventions, like community or family-based models of care could improve its effectiveness.enantiretroviral therapyloss to follow-upoption Bþpregnancyprevention of mother-to-child transmission/vertical transmission retention in care600 - Technology::610 - Medicine & health300 - Social sciences, sociology & anthropology::360 - Social problems & social servicesarticle10.7892/boris.414822446899910.1097/QAD.0000000000000143