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 anti-retroviral 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 one location with one provider; lab courier to expedite CD4 counts; and community-based follow-up of women-infant pairs to improve PMTCT attendance. Pre-intervention HIV-positive pregnant women were referred to HIV clinics for disease stage assessment and cART initiation for advanced disease (CD4 2). Methods: We employed a quasi-experimental design with pre / post-intervention evaluations at 6 government antenatal clinics (ANC) in Southern Province Zambia. Retrospective clinical data were collected from clinic registers during a 7-month baseline period. Post-intervention data were collected from all ART-naive HIV-positive pregnant women and their infants presenting to ANC from December 2011-June 2013. Results: Data from 510 baseline women-infant pairs were analyzed and 624 pregnant women were enrolled during the intervention period. Proportion of HIV-positive pregnant women receiving CD4 counts increased from 50.6% to 77.2% (RR=1.81 95% CI: 1.57-2.08; p<0.01). Proportion of cART-eligible pregnant women initiated on cART increased from 27.5% to 71.5% (RR=2.25 95% CI: 1.78-2.83; p<0.01). 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: 1.18-1.51; p<0.01). Conclusion: Integration of HIV care into ANC and community-based support improved uptake of CD4 counts proportion of cART-eligible women initiated on cART and infants tested. Copyright © 2015 Wolters Kluwer Health Inc. Unauthorized reproduction of this article is prohibited.