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

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Herlihy, Julie M. ; Hamomba, Leoda ; Bonawitz, Rachael ; Goggin, Caitlin E. ; Sambambi, Kennedy ; Mwale, Jonas ; Musonda, Victor ; Musokatwane, Kebby ; Hopkins, Kathryn L. ; Semrau, Katherine ; Hammond, Emily E. ; Duncan, Julie ; Knapp, Anna B. ; Thea, Donald M.
  More +
• Description:
  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.
• Subjects:
  • Adult
  • Anti-Retroviral Agents
  • Cohort Studies
  • Controlled Before-After Studies
  • Female
  • HIV Infections
  • Humans
  • Infant
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical
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• Keywords:
  • HIV
  • AIDS
  • vertical transmission
  • prevention of mother-to-child transmission of HIV
  • integration
  • antenatal services
  • maternal and child health services
  • Option B+
  • community-based follow-up
  • task-shifting
  More +
• Source:
  J Acquir Immune Defic Syndr. 70(4):e123-e129
• Pubmed ID:
  26181813
• Pubmed Central ID:
  PMC6754251
• Document Type:
  Journal Article
• Funding:
  U2G PS001418/PS/NCHHSTP CDC HHSUnited States/ ; 5U2GPS001418/PHS HHSUnited States/
• Place as Subject:
  Zambia
• Volume:
  70
• Issue:
  4
• Download URL:
  https://stacks.cdc.gov/view/cdc/134180/cdc_134180_DS1.pdf
• File Type:
  [PDF - 614.38 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f61f08a7b038a744ee61a3c1933137edcbffa438523313b6223559c1470d0247