Integration of Antiretroviral Treatment Within Antenatal Care in Gauteng Province, South Africa | ICRH

Authors and affiliation: 

Karin van der Merwe (University of the Witwatersrand), Technau(University of the Witwatersrand), Yvonne Umurungi (University of the Witwatersrand), Karl Technau (University of the Witwatersrand) and Ashraf Coovadia (University of the Witwatersrand)Matthew F. Chersich (ICRH-Kenya) Francesca Conradie, (PEPFAR)

Ranking: 

A1

Published: 

J Acquir Immune Defic Syndr. 2006 Dec 15;43(5):577-81

Publication Date: 

15/12/2006

Abstract:Background: Antenatal clinics are a key entry point into HIV treatment and care, together with interventions to reduce mother to child transmission (MTCT). Further evaluation is needed of interventions linking antenatal with antiretroviral (ARV) treatment services and effectiveness of triple ARV regimens for reducing MTCT in resource-constrained settings.  Methods: Data were gathered from HIV-infected women attending antenatal care from June 2004 to July 2005 at Coronation Women and Children Hospital, South Africa. After a patient record review, interventions were implemented to strengthen service linkages and integrate ARV treatment within antenatal care. Laboratory investigations were streamlined, including CD4 cell count testing at the first antenatal visit. MTCT risk for women initiating ARV treatment is compared with that of women-infant pairs receiving single-dose nevirapine (sd-NVP).  Results: In total, 164 pregnant women initiated ARV treatment and 863 received sd-NVP. After changes to service delivery, time-to treatment initiation was reduced from a median of 56 days to 37 days (P = 0.041). The risk of MTCT for women receiving ARV treatment (5 [4.3%] of 116 women) was lower than for those given sd-NVP (74 [10.7%] of 692 women; P = 0.032).  Conclusions: Strengthening linkages and integrating key components of ARV treatment within antenatal care reduces time-to-treatment initiation. In this setting, among women with a high MTCT risk, triple- ARV regimens are effective in reducing HIV infection in infants.