{"doi":"10.1371/journal.pone.0297652","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","abstract":"INTRODUCTION: 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 \"Friends for Life Circles\" (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. METHODS: Between 16 May 2016 and 12 September 2017, 540 ART-naïve 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. RESULTS: 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: 1.199-4.656, 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. CONCLUSIONS: 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). TRIAL REGISTRATION: NCT02515370 (04/08/2015) on ClinicalTrials.gov.","journal":"PLoS ONE","year":2024,"id":436555,"datarank":0.5273177268345635,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.15458172936636339,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.15458172936636339,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":11,"citers_with_citation_signal":5,"citers_with_endowment":5,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.955,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02515370"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":714417,"name":"Grace Gabagaya","orcid":"0000-0001-5327-8610","position":1,"is_corresponding":false},{"id":714419,"name":"Priscilla Wavamunno","orcid":"0000-0001-5064-024X","position":2,"is_corresponding":false},{"id":714418,"name":"Gordon Rukundo","orcid":"0000-0002-2622-5254","position":3,"is_corresponding":false},{"id":714915,"name":"Joyce Namale-Matovu","orcid":null,"position":4,"is_corresponding":false},{"id":704662,"name":"Samuel S. Malamba","orcid":"0000-0001-8087-8849","position":5,"is_corresponding":false},{"id":714916,"name":"Irene Lubega","orcid":null,"position":6,"is_corresponding":false},{"id":525568,"name":"Jaco Homsy","orcid":"0000-0001-5932-4569","position":7,"is_corresponding":false},{"id":291580,"name":"Rachel King","orcid":"0000-0002-0085-3498","position":8,"is_corresponding":false},{"id":319308,"name":"Clemensia Nakabiito","orcid":null,"position":9,"is_corresponding":false},{"id":526411,"name":"Zikulah Namukwaya","orcid":null,"position":10,"is_corresponding":false},{"id":447016,"name":"Mary Glenn Fowler","orcid":"0000-0003-4484-9009","position":11,"is_corresponding":false},{"id":398557,"name":"Philippa Musoke","orcid":null,"position":12,"is_corresponding":false},{"id":525566,"name":"Alexander Amone","orcid":"0000-0001-5920-281X","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T02:00:16.989773Z","pmid":"38640123","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}