Integration of PMTCT and antenatal services improves combination antiretroviral therapy uptake for HIV-positive pregnant women in Southern Zambia: A prototype for option B+?

Julie Herlihy, Leoda Hamomba, Rachael Bonawitz, Caitlin E. Goggin, Kennedy Sambambi, Jonas Mwale, Victor Musonda, Kebby Musokatwane, Kathryn L. Hopkins, Katherine Semrau, Emily E. Hammond, Julie Duncan, Anna B. Knapp, Donald M. Thea

Research output: Contribution to journalArticle

18 Citations (Scopus)

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/mL 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 communitybased support improved uptake of CD4 counts, proportion of cARTeligible women initiated on cART, and infants tested.

Original languageEnglish (US)
Pages (from-to)e123-e129
JournalJournal of Acquired Immune Deficiency Syndromes
Volume70
Issue number4
StatePublished - Dec 1 2015

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Zambia
Pregnant Women
HIV
CD4 Lymphocyte Count
Therapeutics
Confidence Intervals
Prenatal Care
Research Design
Mothers
Polymerase Chain Reaction

Keywords

  • AIDS
  • Antenatal services
  • Attrition
  • Community-based follow-up
  • HIV
  • Integration
  • Loss to follow-up
  • Maternal and child health services
  • Option B+
  • Prevention of mother-to-child transmission of HIV
  • Task-shifting
  • Vertical transmission

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Integration of PMTCT and antenatal services improves combination antiretroviral therapy uptake for HIV-positive pregnant women in Southern Zambia : A prototype for option B+? / Herlihy, Julie; 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.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 70, No. 4, 01.12.2015, p. e123-e129.

Research output: Contribution to journalArticle

Herlihy, J, Hamomba, L, Bonawitz, R, Goggin, CE, Sambambi, K, Mwale, J, Musonda, V, Musokatwane, K, Hopkins, KL, Semrau, K, Hammond, EE, Duncan, J, Knapp, AB & Thea, DM 2015, 'Integration of PMTCT and antenatal services improves combination antiretroviral therapy uptake for HIV-positive pregnant women in Southern Zambia: A prototype for option B+?', Journal of Acquired Immune Deficiency Syndromes, vol. 70, no. 4, pp. e123-e129.
Herlihy, Julie ; 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. / Integration of PMTCT and antenatal services improves combination antiretroviral therapy uptake for HIV-positive pregnant women in Southern Zambia : A prototype for option B+?. In: Journal of Acquired Immune Deficiency Syndromes. 2015 ; Vol. 70, No. 4. pp. e123-e129.
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title = "Integration of PMTCT and antenatal services improves combination antiretroviral therapy uptake for HIV-positive pregnant women in Southern Zambia: A prototype for option B+?",
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/mL 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 communitybased support improved uptake of CD4 counts, proportion of cARTeligible women initiated on cART, and infants tested.",
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T1 - Integration of PMTCT and antenatal services improves combination antiretroviral therapy uptake for HIV-positive pregnant women in Southern Zambia

T2 - A prototype for option B+?

AU - Herlihy, Julie

AU - Hamomba, Leoda

AU - Bonawitz, Rachael

AU - Goggin, Caitlin E.

AU - Sambambi, Kennedy

AU - Mwale, Jonas

AU - Musonda, Victor

AU - Musokatwane, Kebby

AU - Hopkins, Kathryn L.

AU - Semrau, Katherine

AU - Hammond, Emily E.

AU - Duncan, Julie

AU - Knapp, Anna B.

AU - Thea, Donald M.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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/mL 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 communitybased support improved uptake of CD4 counts, proportion of cARTeligible women initiated on cART, and infants tested.

AB - 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/mL 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 communitybased support improved uptake of CD4 counts, proportion of cARTeligible women initiated on cART, and infants tested.

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KW - Attrition

KW - Community-based follow-up

KW - HIV

KW - Integration

KW - Loss to follow-up

KW - Maternal and child health services

KW - Option B+

KW - Prevention of mother-to-child transmission of HIV

KW - Task-shifting

KW - Vertical transmission

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