{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:48:31Z","timestamp":1790268511489,"version":"4.1.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T00:00:00Z","timestamp":1713484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"NIH\/Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"crossref","award":["IR01HD080476-01."],"award-info":[{"award-number":["IR01HD080476-01."]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Introduction<\/jats:title>\n Despite the scale-up of Option B+, long-term retention of women in HIV care during pregnancy and the postpartum period remains an important challenge. We compared adherence to clinic appointments and antiretroviral therapy (ART) at 6 weeks, 6, and and 24 months postpartum among pregnant women living with HIV and initiating Option B+. Women were randomized to a peer group support, community-based drug distribution and income-generating intervention called \u201cFriends for Life Circles\u201d (FLCs) versus the standard of care (SOC). Our secondary outcome was infant HIV status and HIV-free survival at 6 weeks and 18 months postpartum.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Between 16 May 2016 and 12 September 2017, 540 ART-na\u00efve pregnant women living with HIV at urban and rural health facilities in Uganda were enrolled in the study at any gestational age. Participants were randomized 1:1 to the unblinded FLC intervention or SOC at enrolment and assessed for adherence to the prevention of mother-to-child HIV transmission (PMTCT) clinic appointments at 6 weeks, 12, and 24 months postpartum, self-reported adherence to ART at 6 weeks, 6 and 24 months postpartum and supported by plasma HIV-1 RNA viral load (VL) measured at the same time points, retention in care through the end of study, and HIV status and HIV-free survival of infants at 18 months postpartum. The FLC groups were formed during pregnancy within 4 months of enrollment and held monthly meetings in their communites, and were followed up until the last group participant reached 24 months post delivery. We used Log-rank and Chi-Square p-values to test the equality of Kaplan-Meier survival probabilities and hazard rates (HR) for failure to retain in care for any reason by study arm.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There was no significant difference in adherence to PMTCT clinic visits or to ART or in median viral loads between FLC and SOC arms at any follow-up time points. Retention in care through the end of study was high in both arms but significantly higher among participants randomized to FLC (86.7%) compared to SOC (79.3%), p = 0.022. The adjusted HR of visit dropout was 2.4 times greater among participants randomized to SOC compared to FLC (aHR = 2.363, 95% CI: 1.199\u20134.656, p = 0.013). Median VL remained < 400 copies\/ml in both arms at 6 weeks, 6, and 24 months postpartum. Eight of the 431 infants tested at 18 months were HIV positive (1.9%), however, this was not statistically different among mothers enrolled in the FLC arm compared to those in the SOC arm. At 18 months, HIV-free survival of children born to mothers in the FLC arm was significantly higher than that of children born to mothers in the SOC arm.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Our findings suggest that programmatic interventions that provide group support, community-based ART distribution, and income-generation activities may contribute to retention in PMTCT care, HIV-free survival of children born to women living with HIV, and ultimately, to the elimination of mother-to-child HIV transmission (EMTCT).<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n NCT02515370<\/jats:ext-link>\n (04\/08\/2015) on ClinicalTrials.gov.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0297652","type":"journal-article","created":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T13:26:20Z","timestamp":1713533180000},"page":"e0297652","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Enhanced peer-group strategies to support the prevention of mother-to-child HIV transmission leads to increased retention in care in Uganda: A randomized controlled trial"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5920-281X","authenticated-orcid":true,"given":"Alexander","family":"Amone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Gabagaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Wavamunno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2622-5254","authenticated-orcid":true,"given":"Gordon","family":"Rukundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Namale-Matovu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel S.","family":"Malamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Lubega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaco","family":"Homsy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0085-3498","authenticated-orcid":true,"given":"Rachel","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemensia","family":"Nakabiito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zikulah","family":"Namukwaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Glenn","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Musoke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,4,19]]},"reference":[{"key":"pone.0297652.ref001","volume-title":"Programmatic update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: Executive Summary.","author":"World Health Organization","year":"2012"},{"key":"pone.0297652.ref002","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach","author":"World Health Organization","year":"2016"},{"issue":"1","key":"pone.0297652.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-019-3997-1","article-title":"Healthcare worker experiences with Option B+ for prevention of mother-to-child HIV transmission in eSwatini: findings from a two-year follow-up study.","volume":"19","author":"A.L. DiCarlo","year":"2019","journal-title":"BMC health services research"},{"key":"pone.0297652.ref004","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3389\/fpubh.2019.00401","article-title":"Effectiveness of lifelong ART (Option B+) in the prevention of mother-to-child transmission of HIV programme in Zambia: observations based on routinely collected health data.","author":"B. Muyunda","year":"2020","journal-title":"Frontiers in Public Health"},{"issue":"18","key":"pone.0297652.ref005","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1056\/NEJMoa1511691","article-title":"Benefits and risks of antiretroviral therapy for perinatal HIV prevention","volume":"375","author":"MG Fowler","year":"2016","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0297652.ref006","doi-asserted-by":"crossref","first-page":"e175","DOI":"10.1016\/S2352-3018(16)00008-4","article-title":"Retention in care during the first 3 years of antiretroviral therapy for women in Malawi\u2019s option B+ programme: an observational cohort study","volume":"3","author":"AD Haas","year":"2016","journal-title":"The Lancet HIV"},{"issue":"1","key":"pone.0297652.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-018-2058-9","article-title":"Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B+.","volume":"18","author":"PN Atanga","year":"2018","journal-title":"BMC pregnancy and childbirth."},{"issue":"7","key":"pone.0297652.ref008","doi-asserted-by":"crossref","first-page":"e0181096","DOI":"10.1371\/journal.pone.0181096","article-title":"Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model.","volume":"12","author":"A Gamell","year":"2017","journal-title":"PLoS One"},{"issue":"7","key":"pone.0297652.ref009","doi-asserted-by":"crossref","first-page":"e024907","DOI":"10.1136\/bmjopen-2018-024907","article-title":"What interventions are effective in improving uptake and retention of HIV-positive pregnant and breastfeeding women and their infants in prevention of mother to child transmission care programmes in low-income and middle-income countries? A systematic review and meta-analysis","volume":"9","author":"LM Ritchie","year":"2019","journal-title":"BMJ open"},{"key":"pone.0297652.ref010","first-page":"35","article-title":"Adherence to antiretroviral therapy among HIV infected pregnant women in public health sectors: a pilot of Chilenje level one Hospital Lusaka, Zambia.","author":"M Mukosha","year":"2020","journal-title":"The Pan African Medical journal"},{"issue":"5","key":"pone.0297652.ref011","doi-asserted-by":"crossref","first-page":"e0251181","DOI":"10.1371\/journal.pone.0251181","article-title":"What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study","volume":"16","author":"AD Mukose","year":"2021","journal-title":"PloS one."},{"issue":"2","key":"pone.0297652.ref012","first-page":"343","article-title":"Exploring barriers to antiretroviral therapy adherence among pregnant women: A scoping literature review.","volume":"159","author":"Mwamba Kalungwe","year":"2022","journal-title":"Gyn & Obstetrics"},{"key":"pone.0297652.ref013","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/QAI.0000000000001616","article-title":"Retention in HIV Care during Pregnancy and the Postpartum Period in the Option B+ Era: Systematic Review and Meta-Analysis of Studies in Africa.","volume":"77","author":"BA Knettel","year":"2018","journal-title":"Journal of Acquired Immune Deficiency Syndromes. Lippincott Williams and Wilkins"},{"key":"pone.0297652.ref014","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1097\/QAI.0000000000001323","article-title":"Integrating PMTCT into maternal, newborn, and child health and related services: Experiences from the global plan priority countries.","volume":"75","author":"K Kiragu","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0297652.ref015","doi-asserted-by":"crossref","first-page":"11001","DOI":"10.7189\/jogh.11.11001","article-title":"Evidence on the effectiveness of community-based primary health care in improving HIV\/AIDS outcomes for mothers and children in low- and middle-income countries: Findings from a systematic review.","volume":"11","author":"I Mushamiri","year":"2021","journal-title":"J Glob Health"},{"key":"pone.0297652.ref016","author":"Ministry of Health- Uganda","year":"2018","journal-title":"Consolidated Guidelines on the prevention and treatment of HIV and AIDS in Uganda"},{"issue":"(0 2","key":"pone.0297652.ref017","doi-asserted-by":"crossref","first-page":"S114","DOI":"10.1097\/QAI.0000000000000319","article-title":"Improving PMTCT uptake and retention services through novel approaches in peer-based family-supported care in the clinic and community: a three-arm cluster randomized trial (PURE Malawi).","volume":"67","author":"NE Rosenberg","year":"2014","journal-title":"Journal of acquired immune deficiency syndromes"},{"key":"pone.0297652.ref018","doi-asserted-by":"crossref","first-page":"S140","DOI":"10.1097\/QAI.0000000000001357","article-title":"Impact of facility- and community-based peer support models on maternal uptake and and retention in Malawi\u2019s option B+ HIV prevention of mother-to-child transmission program: A 3-arm cluster randomized controlled trial (PURE Malawi).","volume":"75","author":"S Phiri","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"3","key":"pone.0297652.ref019","doi-asserted-by":"crossref","first-page":"e0000256","DOI":"10.1371\/journal.pgph.0000256","article-title":"Effect of peer-mother interactive programme on prevention of mother-to-child HIV transmission outcomes among pregnant women on anti-retroviral treatment in routine healthcare in Dar es Salaam, Tanzania.","volume":"2","author":"GW Lyatuu","year":"2022","journal-title":"PLOS Global Public Health."},{"key":"pone.0297652.ref020","article-title":"SYSTEMATIC REVIEW OF INTERVENTIONS AIMED AT IMPROVING HIV ADHERENCE TO CARE IN LOW-AND MIDDLE-INCOME COUNTRIES","author":"LE Pugh","year":"2022","journal-title":"Journal of Infection and Public Health"},{"issue":"11","key":"pone.0297652.ref021","doi-asserted-by":"crossref","first-page":"e25843","DOI":"10.1002\/jia2.25843","article-title":"Experiences, perceptions and potential impact of community\u2010based mentor mothers supporting pregnant and postpartum women with HIV in Kenya: a mixed\u2010methods study","volume":"24","author":"A Helova","year":"2021","journal-title":"Journal of the International AIDS Society"},{"issue":"1","key":"pone.0297652.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-019-2419-z","article-title":"Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study.","volume":"19","author":"I Wanga","year":"2019","journal-title":"BMC pregnancy and childbirth."},{"key":"pone.0297652.ref023","unstructured":"Ministry of Health- Uganda. National HIV Testing Services Policy and Implementation Guidelines"},{"key":"pone.0297652.ref024","unstructured":"Roche Diagnostics. COBAS \u00ae AmpliPrep\/COBAS \u00ae TaqMan \u00ae HIV-1 Test package insert.: 1\u201336."},{"issue":"1","key":"pone.0297652.ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-019-7280-5","article-title":"Increasing retention of HIV positive pregnant and breastfeeding mothers on option-b plus by upgrading and providing full time HIV services at a lower health facility in rural Uganda.","volume":"19","author":"EM Masereka","year":"2019","journal-title":"BMC public health."},{"key":"pone.0297652.ref026","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.puhe.2022.07.016","article-title":"Adherence to option B+ and its association with disclosure status and counseling among HIV-positive pregnant and lactating women in Ethiopia: systematic review and meta-analysis.","volume":"211","author":"CA Wubneh","year":"2022","journal-title":"Public Health."},{"issue":"9","key":"pone.0297652.ref027","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1093\/cid\/ciw500","article-title":"Adherence to antiretroviral therapy during and after pregnancy: cohort study on women receiving care in Malawi\u2019s option B+ program","volume":"63","author":"AD Haas","year":"2016","journal-title":"Clinical infectious diseases"},{"issue":"2","key":"pone.0297652.ref028","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s10461-016-1448-0","article-title":"A Self-Reported Adherence Measure to Screen for Elevated HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy","volume":"21","author":"T Phillips","year":"2017","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0297652.ref029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12874-018-0646-z","article-title":"A scoping review of the problems and solutions associated with contamination in trials of complex interventions in mental health.","volume":"19","author":"N Magill","year":"2019","journal-title":"BMC medical research methodology."},{"key":"pone.0297652.ref030","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ijid.2018.07.004","article-title":"A meta-analysis of effectiveness of interventions to improve adherence in pregnant women receiving antiretroviral therapy in sub-Saharan Africa","volume":"74","author":"O Omonaiye","year":"2018","journal-title":"International Journal of Infectious Diseases"},{"issue":"6","key":"pone.0297652.ref031","doi-asserted-by":"crossref","first-page":"e0252623","DOI":"10.1371\/journal.pone.0252623","article-title":"The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis.","volume":"16","author":"RC Berg","year":"2021","journal-title":"PLoS One."},{"issue":"Suppl 2","key":"pone.0297652.ref032","doi-asserted-by":"crossref","first-page":"S124","DOI":"10.1097\/QAI.0000000000001062","article-title":"Conditional cash transfers to increase retention in PMTCT care, antiretroviral adherence, and postpartum virological suppression: a randomized controlled trial","volume":"72","author":"M Yotebieng","year":"2016","journal-title":"Journal of acquired immune deficiency syndromes (1999)."},{"issue":"1","key":"pone.0297652.ref033","first-page":"1","article-title":"Conditional cash transfers to prevent mother-to-child transmission in low facility-delivery settings: evidence from a randomised controlled trial in Nigeria.","volume":"19","author":"JX Liu","year":"2019","journal-title":"BMC pregnancy and childbirth."},{"issue":"6","key":"pone.0297652.ref034","doi-asserted-by":"crossref","first-page":"e0270180","DOI":"10.1371\/journal.pone.0270180","article-title":"Understanding the role of incentives for achieving and sustaining viral suppression: A qualitative sub-study of a financial incentives trial in Uganda.","volume":"17","author":"CS Camlin","year":"2022","journal-title":"Plos one."},{"key":"pone.0297652.ref035","article-title":"Adherence levels to antenatal regimens of NVP and AZT among HIV+ women receiving PMTCT treatment at Pumwani Maternity Hospital in Nairobi, Kenya.","author":"CL Imbaya","year":"2008","journal-title":"AIDS 2008\u2014XVII International AIDS Conference: Abstract no MOPE0519"},{"issue":"4","key":"pone.0297652.ref036","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1177\/2010105818760923","article-title":"Do peer support groups have an effect on medication adherence? 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