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J Acquir Immune Defic Syndr. 2015 Dec 1;70(4):e123-9. doi: 10.1097/QAI.0000000000000760.

Implementation and Operational Research: Integration of PMTCT and Antenatal Services Improves Combination Antiretroviral Therapy Uptake for HIV-Positive Pregnant Women in Southern Zambia: A Prototype for Option B+?

Author information

1
*Center for Global Health and Development, Boston University School of Public Health, Boston, MA; †Department of Pediatrics, Boston Medical Center, Boston, MA; ‡Department of Global Health, Boston University School of Public Health, Boston, MA; §Department of Pediatrics, University of California Davis, Sacramento, CA; ‖Zambia Center for Applied Health Research and Development, Lusaka, Zambia; ¶Marie Stopes International, Lilongwe, Malawi; #Centers for Disease Control and Prevention, Lusaka, Zambia; **Ministry of Community Development, Mother and Child Health, Government of the Republic of Zambia, Lusaka, Zambia; and ††Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa.

Abstract

BACKGROUND:

Early initiation of combination antiretroviral therapy (cART) for HIV-positive pregnant women can decrease vertical transmission to less than 5%. Programmatic barriers to early cART include decentralized care, disease-stage assessment delays, and loss to follow-up.

INTERVENTION:

Our intervention had 3 components: integrated HIV and antenatal services in 1 location with 1 provider, laboratory courier to expedite CD4 counts, and community-based follow-up of women-infant pairs to improve prevention of mother-to-child transmission attendance. Preintervention HIV-positive pregnant women were referred to HIV clinics for disease-stage assessment and cART initiation for advanced disease (CD4 count <350 cells/μL or WHO stage >2).

METHODS:

We used a quasi-experimental design with preintervention/postintervention evaluations at 6 government antenatal clinics (ANCs) in Southern Province, Zambia. Retrospective clinical data were collected from clinic registers during a 7-month baseline period. Postintervention data were collected from all antiretroviral therapy-naive, HIV-positive pregnant women and their infants presenting to ANC from December 2011 to June 2013.

RESULTS:

Data from 510 baseline women-infant pairs were analyzed and 624 pregnant women were enrolled during the intervention period. The proportion of HIV-positive pregnant women receiving CD4 counts increased from 50.6% to 77.2% [relative risk (RR) = 1.81; 95% confidence interval (CI): 1.57 to 2.08; P < 0.01]. The proportion of cART-eligible pregnant women initiated on cART increased from 27.5% to 71.5% (RR = 2.25; 95% CI: 1.78 to 2.83; P < 0.01). The proportion of eligible HIV-exposed infants with documented 6-week HIV PCR test increased from 41.9% to 55.8% (RR = 1.33; 95% CI: 1.18 to 1.51; P < 0.01).

CONCLUSIONS:

Integration of HIV care into ANC and community-based support improved uptake of CD4 counts, proportion of cART-eligible women initiated on cART, and infants tested.

PMID:
26181813
PMCID:
PMC6754251
DOI:
10.1097/QAI.0000000000000760
[Indexed for MEDLINE]
Free PMC Article

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