Antiretroviral therapy in antenatal care to increase treatment initiation in HIV-infected pregnant women: a stepped-wedge evaluation

Killam, William P.; Tambatamba, Bushimbwa; Chintu, Namwinga; Rouse, Dwight J.; Stringer, Elizabeth M.; Bweupe, Maximillian; Yu, Yong; Stringer, Jeffrey S. A.

doi:10.1097/qad.0b013e32833298be

Cited by 92 publications

(121 citation statements)

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“…Four studies met the inclusion criteria (Table 1); three of them reported on ART enrolment [30][31][32] and all four reported on ART coverage. [29][30][31][32] All studies were conducted in self-identified ANC clinics; none was conducted in a selfidentified MCH clinic. One study was a prospective cohort study 30 and the other three were retrospective cohort studies.…”

Section: Search Resultsmentioning

confidence: 99%

“…[29][30][31][32] All studies were conducted in self-identified ANC clinics; none was conducted in a selfidentified MCH clinic. One study was a prospective cohort study 30 and the other three were retrospective cohort studies. 29,31,32 Moreover, no studies meeting eligibility criteria were found by contacting experts or by searching the Cochrane Central Register of Controlled Trials, the International Standard Randomized Controlled Trial Number Register, or the reference lists of studies meeting inclusion criteria.…”

Section: Search Resultsmentioning

confidence: 99%

“…[29][30][31] In Rwanda, ART coverage was not significantly higher in ANCs clinics that had integrated ART (RR: 0.90; 95% CI: 0.70-1.10). 32 In one of the included studies, ART retention after 90 days was 87.8% (244/278) in the ANC clinics that had integrated ART and 91.3% (94/103) in the referral HIV clinics for pregnant women on ART.…”

Section: -32mentioning

confidence: 99%

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Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis

Suthar

Hui‐Kang

Beqiri

et al. 2012

Bull. World Health Organ.

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Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

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Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis

Suthar

Hui‐Kang

Beqiri

et al. 2012

Bull. World Health Organ.

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“…This rate was comparable with those reported globally. [18][19][20][21][22][23] The sociodemographic, HIV disease (WHO clinical stage or CD4 cell count), and gestational age at HIV diagnosis were not associated with ART initiation in our study. Data on the importance of these factors in ART acceptance have been questionable, with conflicting results between studies.…”

Section: Discussionmentioning

confidence: 78%

Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland

et al. 2017

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Background. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. Objectives. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland. Methods. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables. Results. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 -5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 -10.67) remained significantly and independently associated with ART initiation. Conclusion. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implemented. Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland Prior to 2013, antiretroviral therapy (ART) was recommended by the World Health Organization (WHO) for HIV-infected pregnant women with CD4 cell counts of <350 cells/µL or those who were at WHO clinical stage III or IV Women who did not meet these criteria,were advised to use one of two options. Option A: antepartum zidovudine, with single-dose nevirapine during labour, and a 7-day zidovudine/lamivudine 'tail' alongside daily infant nevirapine during breastfeeding. Option B: ART during pregnancy and through cessation of breastfeeding to prevent mother-to-child HIV transmission (PMTCT.) [1] Many countries, including Swaziland, chose to implement option A; a CD4 cell count was performed on all women identified to have HIV infection to determine those who should be initiated on life-long ART for both maternal health and PMTCT. In Swaziland, 88% of facilities that provide antenatal care (ANC) services also provide PMTCT services.[2] In 2009, 73% of women attending ANC facilities were tested for HIV, and 88% of HIV-infected pregnant women received a complete course of PMTCT prophylaxis in 2009. [3] However, a review of the data in the Early Infant Diagnosis (EID) database in Swaziland at the time of the introduction of option A guidelines, showed that ~50% of HIV-infected women who were eligible for ART actu...

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“…A systematic review found that ART integration into MNCH facilities significantly improves ART uptake (risk ratio 1.37, 95% confidence interval (CI): 1.05, 1.79) . However, only one study has evaluated the effect of facility-based integration of MNCH and PMTCT on retention in care (Killam et al 2010) and none has evaluated ART adherence.…”

Section: Theory Of Changementioning

confidence: 99%

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

Nance¹,

McCoy²,

Ngilangwa³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programs. We are the global leader in funding, producing and synthesizing high-quality evidence of what works, for whom, why and at what cost. We believe that high-quality and policy-relevant evidence will help make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report3ie accepted the final version of this report, Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania, as partial fulfilment of the requirements of grant TW7.18 issued under Thematic Window 7. The content has been copy-edited and formatted for publication by 3ie. Some of the content does not conform to the series report norms or standards, but has been accepted as is. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors and omissions are the sole responsibility of the authors. Any comments or queries should be directed to the corresponding author, Sandra I McCoy, smccoy@berkeley.edu. AcknowledgementsThe authors would first and foremost like to extend our gratitude toward 3ie for funding this evaluation. We would like to thank the Ministry of Health and Social Welfare of Tanzania, and in particular the Shinyanga Regional Medical Officer Dr Ntuli Kapologwe; without their support, this project would not have been possible.We would also like to thank administrative and research staff at Amref Health Africa and University of California, Berkeley, whose collaboration on the project has been essential. We thank Karen Webb and Barbara Engelsmann at the Organisation for Public Health Interventions and Development in Zimbabwe. Lastly, but most importantly, we are thankful to the health facility staff and other local stakeholders who supported this project, and to the research assistants and the impact evaluation field coordinator who collected the data showcased here.ii Summary Community health workers are key frontline health paraprofessionals who have the potential to enhance the World Health Organization's Option B+ strategy to eliminate mother-to-child transmission of HIV. By extending the reach of health services into communities facing a shortage of skilled health workers, community health workers may enhance retention in prevention of mother-to-child transmission (PMTCT) services, including HIV care and adherence to antiretroviral therapy.To test this hypothesis, we evaluated the Mama na Mtoto Pamoja (Mother and Child Together) intervention that integrated community healt...

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Antiretroviral therapy in antenatal care to increase treatment initiation in HIV-infected pregnant women: a stepped-wedge evaluation

Abstract: An integrated ART in ANC strategy doubled the proportion of treatment-eligible women initiating ART while pregnant.

Cited by 92 publications

References 18 publications

Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis

Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis

Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

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