Discontinuation of cART Postpartum in a high prevalence district of South Africa in 2014 (Implementation Science)

Background: Combination antiretroviral therapy (cART) is the current strategy to prevent mother-to-child transmission (PMTCT) of HIV. Women initiated on cART should continue taking treatment life-long or stop after cessation of breastfeeding depending on their CD4 cell count or World Health Organization (WHO) staging. Keeping people living with HIV on treatment is essential for the success of any anti-retroviral therapy (ART) programme. There has been a rapid scale-up of cART in the PMTCT programme in South Africa. cART is supposed to be taken life-long or until cessation of breastfeeding, but premature or unmanaged discontinuation of cART postpartum is not unusual in South Africa and is confirmed by studies from around the world. Discontinuation of cART can lead to mother-to-child transmission (MTCT), drug resistance and poor maternal outcomes. The extent of this problem in the South African context however is unclear. This study aims to determine the prevalence of and identify risk factors associated with, discontinuation of cART postpartum amongst women who were initiated on antiretroviral treatment during their index pregnancy. Methods: An observational analytic cross-sectional study design will be conducted in six health facilities in a high prevalence district in KwaZulu-Natal, South Africa over a period of three months in 2014. An interviewer-administered questionnaire will be used to collect data from mothers who initiated cART during the index pregnancy. The prevalence of discontinuation of cART postpartum will be measured and the association between those who discontinue cART postpartum and independent variables will be estimated using multivariable adjusted prevalence odds ratios for discontinuation.