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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Antiretroviral therapy in antenatal care to increase treatment initiation in HIV-infected pregnant women: A stepped-wedge evaluation
AIDS, Volume 24, No. 1, Year 2010
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Description
BACKGROUND: The objective of the study was to evaluate whether providing antiretroviral therapy (ART) integrated in antenatal care (ANC) clinics resulted in a greater proportion of treatment-eligible women initiating ART during pregnancy compared with the existing approach of referral to ART. ANALYSIS DESIGN AND METHODS: The evaluation used a stepped-wedge design and included all HIV-infected, ART-eligible pregnant women in eight public sector clinics in Lusaka district, Zambia. Main outcome indicators were the proportion of treatment-eligible pregnant women enrolling into HIV care within 60 days of HIV diagnosis, and of these, the proportion initiating ART during pregnancy. Adjusted odds ratios (AORs) and confidence intervals (CIs) for enrollment and initiation proportions were estimated through a logistic regression model accounting for clinical site cluster and time effects. RESULTS: Between 16 July 2007 and 31 July 2008, 13 917 women started antenatal care more than 60 days before the intervention rollout and constituted the control cohort; 17 619 started antenatal care after ART integrated into ANC and constituted the intervention cohort. Of the 1566 patients found eligible for ART, a greater proportion enrolled while pregnant and within the 60 days of HIV diagnosis in the intervention cohort (376/846, 44.4%) compared with the control cohort (181/716, 25.3%), AOR 2.06, 95% CI (1.27-3.34); and initiated ART while pregnant 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). CONCLUSION: An integrated ART in ANC strategy doubled the proportion of treatment-eligible women initiating ART while pregnant. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Killam, William Perry
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research
Tambatamba, Bushimbwa
Zambia, Lusaka
Zambian Ministry of Health
Chintu, Namwinga T.
Zambia, Lusaka
Centre for Infectious Disease Research
Rouse, Dwight J.
United States, Birmingham
The University of Alabama at Birmingham
Stringer, Elizabeth Mc Phillips
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research
Bweupe, Maxmillian
Zambia, Lusaka
Zambian Ministry of Health
Yu, Yong
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research
Stringer, Jeffrey S.A.
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research
Statistics
Citations: 118
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1097/QAD.0b013e32833298be
e-ISSN:
14735571
Research Areas
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Zambia
Participants Gender
Female