Integrating quality postnatal care into PMTCT in Swaziland

Mazia, Goldy; Narayanan, Indira; Warren, Charlotte E.; Mahdi, Mohammed; Chibuye, Peggy S.; Walligo, A; Mabuza, Poppy Lydia; Shongwe, Rachel; Hainsworth, Michael

doi:10.1080/17441690902769669

Cited by 26 publications

(32 citation statements)

References 7 publications

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“…6,8 Low coverage may be partially explained by the initial introduction of PMTCT programs as stand-alone vertical programs. 9–11 In addition, PMTCT interventions create significant additional work for staff in healthcare systems already suffering from insufficient human, financial, and structural resources. 12 Thus, PMTCT implementation is suboptimal and has not produced the expected reduction in MTCT rates.…”

Section: Introductionmentioning

confidence: 99%

Implementation and Operational Research

Turan

Onono

Steinfeld³

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. The current study aimed to determine if integration of HIV services into ANC settings improves PMTCT service utilization outcomes. Methods ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or non-integrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), while control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. Results HIV care enrollment was higher in intervention compared to control clinics (69% versus 36%, Odds Ratio (OR)=3.94, 95% Confidence Interval (CI): 1.14–13.63). Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, Hazard Ratio (HR)=2.20, 95% CI: 1.62–3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%, OR=3.22, 95% CI: 1.81–5.72). Infant testing was more common in the intervention arm (25% versus 18%), however not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. Conclusions Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions.

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Section: Introductionmentioning

confidence: 99%

Implementation and Operational Research

Turan

Onono

Steinfeld³

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Ongoing research in the IMPAACT P1077 PROMISE trial will provide further information in the future as to the best of these approaches to reduce transmission through breastfeeding, and whether stopping prophylactic HAART has any long-term adverse impact on maternal health. Translation of these research findings into real impact depends on the improvement of services to reach and care for HIV-infected mothers and their children [48,73–77]. Without significant efforts to improve the coverage and quality of PMTCT services and better use of these to provide access to ongoing treatment for women, we will not achieve the maximum benefit from antiretroviral use in pregnancy in low-resource settings.…”

Section: Resultsmentioning

confidence: 99%

Use of antiretrovirals during pregnancy and breastfeeding in low-income and middle-income countries

McIntyre

2010

Current Opinion in HIV and AIDS

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Purpose of review The purpose of the study was to review recent evidence on the use of antiretrovirals during pregnancy and breastfeeding in low-income and middle-income settings. Recent findings Access to antiretroviral prophylaxis strategies for HIV-infected pregnant women has increased globally, but two-thirds of women in need still do not receive even the simplest regimen for the prevention of mother-to-child transmission of HIV, and most pregnant women in need of antiretroviral treatment do not receive it. The use of combination antiretroviral treatment in pregnancy in low-resource settings is safe and effective, and increasing evidence supports starting ongoing antiretroviral treatment at a CD4 cell count below 350/μl in pregnant women. The use of appropriate short-course antiretroviral prophylactic regimens is effective for prevention of mother-to-child transmission of HIV in women with higher CD4 cell counts. New data on the use of antiretroviral prophylaxis to prevent transmission through breastfeeding demonstrate that both maternal antiretroviral treatment and extended infant prophylaxis are effective. Summary Antiretroviral use in pregnancy can benefit mothers in need of treatment and reduce the risk of mother-to-child transmission. Emerging evidence of the effectiveness of antiretroviral prophylaxis in preventing transmission through breastfeeding is encouraging and likely to influence practice in the future.

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“…4,26-32 In 2009, the NIH Office of AIDS Research identified as a top priority research on how to promote women's linkage to and retention in care at each step of the PMTCT cascade. 33 This study demonstrates that although we are able to enroll more women in HIV care through integration, integration alone does not necessarily translate to improved maternal health outcomes or decreased rates of mother-to-child transmission of HIV, as compared to non-integrated services.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Operational Research

Washington

Owuor

Turan

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Many HIV-infected pregnant women identified during antenatal care do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants. Methods We performed a cluster-randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, PMTCT, and HIV care delivered in the ANC clinic; n=6 intervention facilities), or standard ANC services (including PMTCT and referral to a separate clinic for HIV care; n=6 control facilities). Results There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was twelve month follow up data for 256/611 (41.8%) women, and postpartum data for only 325/1172 (28%) women. By 9 months of age, 382/568 (67.3%) infants at intervention sites and 338/594 (57.0%) at control sites had tested for HIV (OR 1.45, 95% CI 0.71-2.82); 7.3% of infants tested HIV-positive at intervention sites compared to 8.0% of infants at control sites (OR 0.89, 95% CI 0.56-1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1 %, OR 0.83, 95% CI 0.41 - 1.68). Conclusions Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk HIV transmission to infants and did not appear to affect short-term maternal health outcomes.

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Integrating quality postnatal care into PMTCT in Swaziland

Cited by 26 publications

References 7 publications

Implementation and Operational Research

Implementation and Operational Research

Use of antiretrovirals during pregnancy and breastfeeding in low-income and middle-income countries

Implementation and Operational Research

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