Details:

Alternative Title:
J Acquir Immune Defic Syndr
Publisher's site:
http://dx.doi.org/10.1097/QAI.0000000000000781
Personal Author:
Edmonds, Andrew; Feinstein, Lydia; Okitolonda, Vitus; Thompson, Deidre; Kawende, Bienvenu; ... More +
Edmonds, Andrew; Feinstein, Lydia; Okitolonda, Vitus; Thompson, Deidre; Kawende, Bienvenu; Behets, Frieda; Less -
Description:
Background The consequences of decentralizing prevention of mother-to-child HIV transmission and HIV-exposed infant services to antenatal care (ANC)/labor and delivery (L&D) sites from dedicated HIV care and treatment (C&T) centers remain unknown, particularly in low prevalence settings. Methods In a cohort of mother–infant pairs, we compared delivery of routine services at ANC/L&D and C&T facilities in Kinshasa, Democratic Republic of Congo from 2010–2013, using methods accounting for competing risks (eg, death). Women could opt to receive interventions at 90 decentralized ANC/L&D sites, or 2 affiliated C&T centers. Additionally, we assessed decentralization’s population-level impacts by comparing proportions of women and infants receiving interventions before (2009–2010) and after (2011–2013) decentralization. Results Among newly HIV-diagnosed women (N = 1482), the 14-week cumulative incidence of receiving the package of CD4 testing and zidovudine or antiretroviral therapy was less at ANC/L&D [66%; 95% confidence interval (CI): 63% to 69%] than at C&T (88%; 95% CI: 83% to 92%) sites (subdistribution hazard ratio, 0.62; 95% CI: 0.55 to 0.69). Delivery of cotrimoxazole and DNA polymerase chain reaction testing to HIV-exposed infants (N = 1182) was inferior at ANC/L&D sites (subdistribution hazard ratio, 0.84; 95% CI: 0.76 to 0.92); the 10-month cumulative incidence of the package at ANC/L&D sites was 89% (95% CI: 82% to 93%) versus 97% (95% CI: 93% to 99%) at C&T centers. Receipt of the pregnancy (20% of 1518, to 64% of 1405) and infant (16%–31%) packages improved post decentralization. Conclusions Services were delivered less efficiently at ANC/L&D sites than C&T centers. Although access improved with decentralization, its potential cannot be realized without sufficient and sustained support.
Subject:
[+]
Adolescent
Adult
Anti-Retroviral Agents
Article
Cohort Studies
Female
Health Services Accessibility
HIV Infections
Humans
Infant
Infant, Newborn
Infectious Disease Transmission, Vertical
Medication Adherence
Postnatal Care
Pregnancy
Pregnancy Complications, Infectious
Prenatal Care
Young Adult

Source:
J Acquir Immune Defic Syndr. 70(4):e130-e139;
Pubmed ID:
26262776
Pubmed Central ID:
PMC4856046
Document Type:
Journal Article;
Funding:
U2G PS001179/PS/NCHHSTP CDC HHS/United States; U62/CCU422422/PHS HHS/United States; P30-AI50410/AI/NIAID NIH HHS/United States; 5U2GPS001179-01/PHS HHS/United States; T32 HD007168/HD/NICHD NIH HHS/United States; ... More +
U2G PS001179/PS/NCHHSTP CDC HHS/United States; U62/CCU422422/PHS HHS/United States; P30-AI50410/AI/NIAID NIH HHS/United States; 5U2GPS001179-01/PHS HHS/United States; T32 HD007168/HD/NICHD NIH HHS/United States; T32 AI070114/AI/NIAID NIH HHS/United States; P2C HD050924/HD/NICHD NIH HHS/United States; P30 AI050410/AI/NIAID NIH HHS/United States; Less -
Place as Subject:
Democratic Republic of the Congo;
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:ac5a38d8f3f092f2ceb6a289e0839265e2a8b45e533484ade6134b18f4a7724e
File Type:

Supporting Files

• 	NIHMS759581-supplement-SDC.pdf	pdf
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