Only 4% of pregnant women start treatment within six months of HIV diagnosis, Kenya.
Article Type: Medical condition overview
Subject: Pregnant women (Health aspects)
Pregnant women (Care and treatment)
HIV (Viruses) (Diagnosis)
HIV (Viruses) (Care and treatment)
Health attitudes (Research)
Pub Date: 05/01/2012
Publication: Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2012 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2012 Source Volume: 20 Source Issue: 39
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: Kenya Geographic Code: 6KENY Kenya
Accession Number: 296571607
Full Text: A retrospective study of routine hospital data from two government hospitals in Rift Valley province, Kenya, measured drop-out rates among pregnant women who tested HIV-positive in a pregnancy-related service. Of the 1,129 women registered at antenatal care or delivery services at the two hospitals between I January 2008 and 30 June 2010, only 17.2% (Naivasha hospital) and 35.4% (Gilgil hospital) registered at the hospitals' HIV clinic within six months of diagnosis. Of these, the number getting a CD4 cell count test were 68% and 43%, respectively, of which only 40% and 27% of eligible women started antiretroviral therapy. Only 4% of women estimated to need HIV treatment for their own care initiated such treatment within six months of HIV diagnosis.

Women who came for only one pregnancy-related service had the lowest level of registration at the HIV clinic. Contrary to previous research, no association was found between uptake of HIV services and transport costs/long travel times between women's homes and the hospital. There was a greater frequency of women being escorted to the HIV clinic at Gilgil. Nurses in Naivasha reported not registering women at their first visit to the HIV clinic due to low return rates, which may have affected numbers registered. The cost and difficulties of getting CD4 tests added to the low levels of service uptake. The hospitals were in areas where there was high mobilty, which may also have increased drop-out rates.

The authors suggest a number of innovations for improving service delivery to increase uptake, including hospital tracking systems using computer networks or duplicate referral forms reconciled monthly and free point-of-care CD4 testing on the same day as the HIV diagnosis, especially among asymptomatic women. Kenyan guidelines stress the importance of reducing vertical transmission but put less emphasis on the health benefit to the woman herself, which should be addressed. (1)

(1.) Ferguson L, Lewis J, Grant AD, et al. Patient attrition between diagnosis with HIV in pregnancy-related services in Kenya: a retrospective study. Journal of Acquired Immune Deficiency Syndrome 2012. E-pub ahead of print. Doi: 10.1097/QAI.0b013e318253258.

Doi: 10.1016/S0968-8080(12)39622-5
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