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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Ensuring HIV-infected pregnant women start antiretroviral treatment: An operational cohort study from Lilongwe, Malawi
Tropical Medicine and International Health, Volume 17, No. 6, Year 2012
Notification
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Description
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 6months. Between 2006 and 2009, the median (IQR) time between CD4 blood draw and ART initiation fell from 41days (17, 349) to 15days (7,42) (P=0.183); the proportion of eligible individuals starting ART while pregnant and retained for 6months 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 14days. 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. © 2012 Blackwell Publishing Ltd.
Authors & Co-Authors
Weigel, Ralf
Malawi, Lilongwe
Kamuzu Central Hospital
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Hosseinipour, Mina C.
Malawi, Lilongwe
Unc Project-malawi
Feldacker, Caryl
Malawi, Lilongwe
Kamuzu Central Hospital
United States, Seattle
University of Washington
Gareta, Dickman
Malawi, Lilongwe
Kamuzu Central Hospital
Tweya, Hannock M.
Malawi, Lilongwe
Kamuzu Central Hospital
France, Paris
International Union Against Tuberculosis and Lung Disease
Chiwoko, Jane
Malawi, Lilongwe
Kamuzu Central Hospital
Gumulira, Joe
Malawi, Lilongwe
Kamuzu Central Hospital
Kalulu, Mike Tikhalenawo
Malawi, Lilongwe
Kamuzu Central Hospital
Malawi, Blantyre, Southern Region
District Health Office
Mofolo, Innocent A.
Malawi, Lilongwe
Unc Project-malawi
Kamanga, Esmie
Malawi, Lilongwe
Unc Project-malawi
Mwale, Gertrude
Malawi, Lilongwe
Unc Project-malawi
Kadzakumanja, Angela
Malawi, Lilongwe
Unc Project-malawi
Jere, Edward
Malawi, Lilongwe
Unc Project-malawi
Phiri, Sam John Peter
Malawi, Lilongwe
Kamuzu Central Hospital
Statistics
Citations: 28
Authors: 14
Affiliations: 6
Identifiers
Doi:
10.1111/j.1365-3156.2012.02980.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Malawi
Participants Gender
Female