TY - JOUR
T1 - Ensuring HIV-infected pregnant women start antiretroviral treatment: an operational cohort study from Lilongwe, Malawi
AU - Weigel, Ralf
AU - Hosseinipour, Mina C.
AU - Feldacker, Caryl
AU - Gareta, Dickman
AU - Tweya, Hannock
AU - Chiwoko, Jane
AU - Gumulira, Joe
AU - Kalulu, Mike
AU - Mofolo, Innocent
AU - Kamanga, Esmie
AU - Mwale, Gertrude
AU - Kadzakumanja, Angela
AU - Jere, Edward
AU - Phiri, Sam
PY - 2012/4/1
Y1 - 2012/4/1
N2 - Objectives: HIV-infected women identified through antenatal care (ANC) often fail to access antiretroviral treatment (ART), leaving them and their infants at risk for declining health or HIV transmission. We describe results of measures to improve uptake of ART among eligible pregnant women.Methods: Between October 2006 and December 2009, interventions implemented at ANC and ART facilities in urban Lilongwe aimed to better link services for women with CD4 counts <250/μl. A monitoring system followed women referred for ART to examine trends and improve practices in referral completion, on-time ART initiation and ART retention.Results: Six hundred and twelve women were ART eligible: 604 (99%) received their CD4 result, 344 (56%) reached the clinic, 286 (47%) started ART while pregnant and 261 (43%) were either alive on ART or transferred out after 6 months. Between 2006 and 2009, the median (IQR) time between CD4 blood draw and ART initiation fell from 41 days (17, 349) to 15 days (7,42) (P = 0.183); the proportion of eligible individuals starting ART while pregnant and retained for 6 months improved from 17% to 65% (P < 0.001). Delays generally shortened within the continuum of care from 2006 to 2009; however, time from CD4 blood draw to ART referral increased from 7 to 14 days.Conclusions: Referrals between facilities and delays through CD4 count measurements create bottlenecks in patient care. Retention improved over time, but delays within the linkage process remained. ART initiation at ANC plus use of point-of-care CD4 tests may further enhance ART uptake.
AB - Objectives: HIV-infected women identified through antenatal care (ANC) often fail to access antiretroviral treatment (ART), leaving them and their infants at risk for declining health or HIV transmission. We describe results of measures to improve uptake of ART among eligible pregnant women.Methods: Between October 2006 and December 2009, interventions implemented at ANC and ART facilities in urban Lilongwe aimed to better link services for women with CD4 counts <250/μl. A monitoring system followed women referred for ART to examine trends and improve practices in referral completion, on-time ART initiation and ART retention.Results: Six hundred and twelve women were ART eligible: 604 (99%) received their CD4 result, 344 (56%) reached the clinic, 286 (47%) started ART while pregnant and 261 (43%) were either alive on ART or transferred out after 6 months. Between 2006 and 2009, the median (IQR) time between CD4 blood draw and ART initiation fell from 41 days (17, 349) to 15 days (7,42) (P = 0.183); the proportion of eligible individuals starting ART while pregnant and retained for 6 months improved from 17% to 65% (P < 0.001). Delays generally shortened within the continuum of care from 2006 to 2009; however, time from CD4 blood draw to ART referral increased from 7 to 14 days.Conclusions: Referrals between facilities and delays through CD4 count measurements create bottlenecks in patient care. Retention improved over time, but delays within the linkage process remained. ART initiation at ANC plus use of point-of-care CD4 tests may further enhance ART uptake.
KW - Antiretroviral treatment
KW - HIV
KW - HIV prevention of mother-to-child transmission
KW - Malawi
KW - Pregnancy
KW - Referral system strengthening
KW - Sub-Saharan Africa
U2 - 10.1111/j.1365-3156.2012.02980.x
DO - 10.1111/j.1365-3156.2012.02980.x
M3 - Article
SN - 1360-2276
VL - 17
SP - 751
EP - 759
JO - Tropical Medicine and International Health
JF - Tropical Medicine and International Health
IS - 6
ER -
