Abstract
BackgroundThe introduction of antiretroviral therapy (ART) in South Africa began as part of the prevention of mother-to-child transmission programme. For significant reduction of vertical transmission, early antenatal care booking and ART initiation are necessary.AimThis study aimed to evaluate ART initiation and booking practices of women attending antenatal care in eThekwini district during financial years (FY) 2010/2011 and 2013/2014.MethodsAn observational study used a retrospective chart review at four eThekwini district community health centres (CHC). From these CHCs, records of women that initiated ART in FY10/11 and FY13/14 were reviewed and compared for ART initiation delays and booking practices.ResultsA total of 2749 pregnant women who attended antenatal care (ANC) at the study sites were found eligible for ART; of these, 49% (n = 1334) attended ANC in FY10/11 while 51% (n = 1414) attended in FY13/14. In FY10/11, 46% (n = 610) and 60 % (n = 855) of the women were initiated on ART during pregnancy. The mean gestational age at booking for FY10/11 was 20.88 (standard deviation [s.d.] = 5.6) and 18.40 (s.d. = 6.2) in FY13/14. The mean gestational age at ART initiation for women who initiated ART in FY10/11 was 26.30 (s.d. = 6.02) and in FY13/14 it was 19.06 (s.d. = 6.86).ConclusionIn FY13/14 ART initiations occurred within 4 days after booking. ANC booking before 20 weeks was found to have improved between the two years from 39% to 58%; however, on average, in both years women booked during the second trimester.
Highlights
In sub-Saharan Africa, women of reproductive age are reported to be the most affected by the human immunodeficiency virus (HIV), and in South Africa the antenatal care (ANC) HIV prevalence for 2013 was reported to be 29.7% nationally and 40.1% for eThekwini District in the KwaZulu-Natal (KZN) province.[1]
The gestational ages for antiretroviral therapy (ART) initiations in the second trimester mentioned in these studies and FY10/11 of this study showed an improvement from the median gestational age of 32 weeks reported by Stinson et al.[17]
The introduction of nurse-initiated management of ART (NIMART) in the prevention of mother-to-child transmission (PMTCT) programme was meant to result in improved quality of care for pregnant women living with HIV
Summary
In sub-Saharan Africa, women of reproductive age are reported to be the most affected by the human immunodeficiency virus (HIV), and in South Africa the antenatal care (ANC) HIV prevalence for 2013 was reported to be 29.7% nationally and 40.1% for eThekwini District in the KwaZulu-Natal (KZN) province.[1]. In an observational cohort study, Fitzgerald et al established that women presented for their first ANC visit at a median gestational age of 28 weeks, with 25% of women presenting after 31 weeks. According to this PMTCT study, late ANC booking resulted in the women missing the necessary ART exposure for effective reduction of vertical transmission.[3]. For significant reduction of vertical transmission, early antenatal care booking and ART initiation are necessary
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