ART offered at antenatal clinics doubles uptake in Lusaka.
Article Type: Brief article
Subject: Highly active antiretroviral therapy (Dosage and administration)
Maternal health services (Standards)
Pregnant women (Care and treatment)
Pub Date: 05/01/2010
Publication: Name: Reproductive Health Matters Publisher: Reproductive Health Matters Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2010 Source Volume: 18 Source Issue: 35
Topic: Event Code: 350 Product standards, safety, & recalls
Geographic: Geographic Scope: Zambia Geographic Code: 6ZAMB Zambia
Accession Number: 236247766
Full Text: In Lusaka, Zambia, the model of HIV treatment for pregnant women is referral from antenatal care (ANC) clinics to a separate antiretroviral therapy (ART) clinic located on the same site but physically separate and staffed separately. This study evaluated whether providing ART integrated in ANC clinics resulted in more treatment-eligible women initiating ART during pregnancy compared with the existing approach. The integration programme was rolled out one clinic at a time (stepped-wedge design) and the study included all HIV-positive, ART-eligible pregnant women attending the eight Lusaka public sector district clinics. Between July 2007 and July 2008, 13,917 women started ANC more than 60 days before the intervention rollout and constituted the control cohort. 17,619 started ANC after integration and constituted the intervention cohort. Each clinic acted as its own control. Of the 1,566 patients found eligible for ART, more than twice the proportion enrolled in ART clinics while pregnant and within 60 days of HIV diagnosis in the intervention cohort (376/846, 44.4%) compared with the control cohort (181/716, 25.3%) (adjusted odds ratio 2.06, 95% CI 1.27-3.34); and initiated ART while pregnant more often in the intervention cohort (278/846, 32.9%) compared with the control cohort (103/716, 14.4%) (AOR 2.01, 95% CI 1.37-2.95). Reasons for success may be that pregnant women do not want to deal with going to two separate clinics, there are poor staff attitudes in ART clinics towards pregnant women, and that an integrated clinic has more interest in providing ART to pregnant women. However, over 60% of those in need are still not accessing treatment, and uptake should be further improved. (1)

(1.) Killam WP, Tambatamba BC, Chintu N, et al. Antiretroviral therapy in antenatal care to increase treatment initiation in HIV-infected pregnant women: a stepped-wedge evaluation. AIDS 2010; 24(1):85-91.
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