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

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Washington, Sierra ; Owuor, Kevin ; Turan, Janet M. ; Steinfeld, Rachel L. ; Onono, Maricianah ; Shade, Starley B. ; Bukusi, Elizabeth A. ; Ackers, Marta L. ; Cohen, Craig R.
• Description:
  Background ; 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. ; Methods ; 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). ; Results ; 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). ; Conclusions ; 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.
• Subjects:
  • Article
  • HIV/AIDS
  • prevention of mother-to-child transmission
  • service integration
  • cluster randomized controlled trial
  • Africa
  • Adult
  • Anti-HIV Agents
  • Antiretroviral Therapy, Highly Active
  • Cluster Analysis
  More +
• Source:
  J Acquir Immune Defic Syndr. 69(5):e164-e171.
• Pubmed ID:
  25886930
• Pubmed Central ID:
  PMC4837126
• Document Type:
  Journal Article
• 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
• Place as Subject:
  Kenya
• Volume:
  69
• Issue:
  5
• Download URL:
  https://stacks.cdc.gov/view/cdc/39045/cdc_39045_DS1.pdf
• File Type:
  [PDF - 666.52 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d695d9d7cba9dc6bfdc3a1bbf0acff06bca4469aa2e637f12861486e166d3fb9