The effect of integration of HIV care and treatment into antenatal care clinics on mother-to-child HIV transmission and maternal outcomes in Nyanza, Kenya: results from the SHAIP cluster randomized controlled trial
Published Date:Aug 15 2015
Source:J Acquir Immune Defic Syndr. 69(5):e164-e171.
Antiretroviral Therapy, Highly Active
Cluster Randomized Controlled Trial
Community Health Centers
Health Plan Implementation
Infectious Disease Transmission, Vertical
Maternal-Child Health Centers
Prevention Of Mother-to-child Transmission
Pubmed Central ID:PMC4837126
Funding:5U2GPS001913-02/PHS HHS/United States
K01 MH081777/MH/NIMH NIH HHS/United States
K01MH081777/MH/NIMH NIH HHS/United States
U2G PS001913/PS/NCHHSTP CDC HHS/United States
U62 PS924511/PS/NCHHSTP CDC HHS/United States
Many HIV-infected pregnant women identified during antenatal care do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants.
We performed a cluster-randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, PMTCT, and HIV care delivered in the ANC clinic; n=6 intervention facilities), or standard ANC services (including PMTCT and referral to a separate clinic for HIV care; n=6 control facilities).
There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was twelve month follow up data for 256/611 (41.8%) women, and postpartum data for only 325/1172 (28%) women. By 9 months of age, 382/568 (67.3%) infants at intervention sites and 338/594 (57.0%) at control sites had tested for HIV (OR 1.45, 95% CI 0.71-2.82); 7.3% of infants tested HIV-positive at intervention sites compared to 8.0% of infants at control sites (OR 0.89, 95% CI 0.56-1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1 %, OR 0.83, 95% CI 0.41 - 1.68).
Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk HIV transmission to infants and did not appear to affect short-term maternal health outcomes.
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