Abstract

BackgroundAs the number of HIV-infected women initiating lifelong antiretroviral therapy (ART) during pregnancy increases globally, concerns have emerged regarding low levels of retention in HIV services and suboptimal adherence to ART during the postpartum period. We examined the impact of integrating postpartum ART for HIV+ mothers alongside infant follow-up within maternal and child health (MCH) services in Cape Town, South Africa.Methods and findingsWe conducted a randomised trial among HIV+ postpartum women aged ≥18 years who initiated ART during pregnancy in the local antenatal care clinic and were breastfeeding when screened before 6 weeks postpartum. We compared an integrated postnatal service among mothers and their infants (the MCH-ART intervention) to the local standard of care (control)—immediate postnatal referral of HIV+ women on ART to general adult ART services and their infants to separate routine infant follow-up. Evaluation data were collected through medical records and trial measurement visits scheduled and located separately from healthcare services involved in either arm. The primary trial outcome was a composite endpoint of women’s retention in ART care and viral suppression (VS) (viral load < 50 copies/ml) at 12 months postpartum; secondary outcomes included duration of any and exclusive breastfeeding, mother-to-child HIV transmission, and infant mortality. Between 5 June 2013 and 10 December 2014, a total of 471 mother–infant pairs were enrolled and randomised (mean age, 28.6 years; 18% nulliparous; 57% newly diagnosed with HIV in pregnancy; median duration of ART use at randomisation, 18 weeks). Among 411 women (87%) with primary endpoint data available, 77% of women (n = 155) randomised to the MCH-ART intervention achieved the primary composite outcome of retention in ART services with VS at 12 months postpartum, compared to 56% of women (n = 117) randomised to the control arm (absolute risk difference, 0.21; 95% CI: 0.12–0.30; p < 0.001). The findings for improved retention in care and VS among women in the MCH-ART intervention arm were consistent across subgroups of participants according to demographic and clinical characteristics. The median durations of any breastfeeding and exclusive breastfeeding were longer in women randomised to the intervention versus control arm (6.9 versus 3.0 months, p = 0.006, and 3.0 versus 1.4 months, p < 0.001, respectively). For the infants, overall HIV-free survival through 12 months of age was 97%: mother-to-child HIV transmission was 1.2% overall (n = 4 and n = 1 transmissions in the intervention and control arms, respectively), and infant mortality was 1.9% (n = 6 and n = 3 deaths in the intervention and control arms, respectively), and these outcomes were similar by trial arm. Interpretation of these findings should be qualified by the location of this study in a single urban area as well as the self-reported nature of breastfeeding outcomes.ConclusionsIn this study, we found that integrating ART services into the MCH platform during the postnatal period was a simple and effective intervention, and this should be considered for improving maternal and child outcomes in the context of HIV.Trial registrationClinicalTrials.gov NCT01933477.

Highlights

  • The past decade has witnessed a paradigm shift in the science of and services for prevention of mother-to-child HIV transmission (PMTCT) [1,2]

  • We found that integrating antiretroviral therapy (ART) services into the maternal and child health (MCH) platform during the postnatal period was a simple and effective intervention, and this should be considered for improving maternal and child outcomes in the context of HIV

  • We examined the impact of integrating postpartum ART for HIV+ mothers and infant follow-up within MCH services on maternal retention in care and viral suppression (VS) through 12 months postpartum in Cape Town, South Africa

Read more

Summary

Introduction

The past decade has witnessed a paradigm shift in the science of and services for prevention of mother-to-child HIV transmission (PMTCT) [1,2]. Lifelong triple-drug antiretroviral therapy (ART) for all women living with HIV regardless of disease status (per the World Health Organization’s Option B+ approach) has emerged as the standard for reducing vertical HIV transmission and promoting maternal health [3] With this approach, there have been substantial increases globally in ART use by HIV+ pregnant and postpartum women, with consequent reductions in new paediatric HIV infections, providing a potent example of the synergies of ART use for HIV treatment and prevention [4]. Alongside the successes of universal ART for pregnant and postpartum women, multiple studies from around the world have raised major concerns regarding low levels of retention in HIV services and adherence to ART medications in this population [5,6,7,8] These findings appear especially marked in the postpartum period and contribute directly to failures in maintaining viral suppression (VS) [8,9]. We examined the impact of integrating postpartum ART for HIV+ mothers alongside infant follow-up within maternal and child health (MCH) services in Cape Town, South Africa.

Objectives
Methods
Results
Conclusion
Full Text
Paper version not known

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call