Retention, transfer out and loss to follow-up 2 years after delivery in a cohort of HIV+ pregnant women in Malawi

In this study, we analysed in a cohort of pregnant women followed for 2 years, the proportion of women remaining followed at the site, of those transferred to other clinics and of those lost to follow-up. The possible determinants of the loss to follow-up were also assessed in a setting of postpartum discontinuation based on CD4+ count. A total of 311 pregnant women received antiretroviral therapy from week 25 of gestational age until 6 months postpartum (end of breastfeeding period), or indefinitely if meeting the criteria for treatment (baseline CD4+ <350/mm(3)). Twenty-four months after delivery six women had died, 247 were in active follow-up, 21 had transferred to another antiretroviral therapy clinic and 37 were lost to follow-up (rate of loss to follow-up 13%, 95% CI 9.1-16.9%). The presence of a baseline CD4+ count above 350/mm(3) was associated with a 10-fold higher risk of loss to follow-up after 6 months of delivery (hazard ratio: 9.8, 95% CI 2.2-42.7, for baseline CD4 >350/mm(3) versus baseline CD4+ count below 350/mm(3), p = 0.002). This finding suggests that discontinuation of drugs when the risk of transmission is ceased can have a negative impact on the retention in care of these women.