Antiretroviral treatment
(ART) initiation in HIV-infected pregnant women in sub-Saharan Africa (SSA)
remains inadequate, and there is a severe shortage of professional healthcare
workers in the region. The effectiveness of community support programmes for
HIV-infected pregnant women and their infants in SSA is unclear.
This study
compared initiation of maternal antiretrovirals and infant outcomes amongst
HIV-infected pregnant women and their infants who received and did not receive
community-based support (CBS) in a high HIV-prevalence setting in South Africa.
A cohort study, including HIV-infected pregnant women and their
infants, was conducted at three sentinel surveillance facilities between
January 2009 and June 2012, utilising enhanced routine clinical data.
Through
home visits, CBS workers encouraged uptake of interventions in the ART cascade,
provided HIV-related education, ART initiation counselling and psychosocial
support. Outcomes were compared using Kaplan-Meier analyses and multivariable
Cox and log-binomial regression. Amongst 1105 mother-infant pairs included, 264
(23.9%) received CBS. Amongst women eligible to start ART antenatally, women
who received CBS had a reduced risk of not initiating antenatal ART, 5.4% vs.
30.3%; adjusted risk ratio (aRR) = 0.18 (95% CI: 0.08-0.44; P < .0001).
Women who received CBS initiated antenatal ART with less delay after the first
antenatal visit, median 26 days vs. 39 days; adjusted hazard ratio (aHR) = 1.57
(95% CI: 1.15-2.14; P = .004). Amongst women who initiated antenatal zidovudine
(ZDV) to prevent vertical transmission, women who received CBS initiated ZDV
with less delay, aHR = 1.52 (95% CI: 1.18-2.01; P = .001). Women who received
CBS had a lower risk of stillbirth, 1.5% vs. 5.4%; aRR = 0.24 (95% CI:
0.07-1.00; P = .050).
Pregnant women living with HIV who received CBS had
improved antenatal triple ART initiation in eligible women, women initiated ART
and ZDV with shorter delays, and had a lower risk of stillbirth. CBS is an
intervention that shows promise in improving maternal and infant health in high
HIV-prevalence settings.
Purchase full article at: http://goo.gl/AoZiwS
By:
- 1 Kheth'Impilo , Cape Town , South Africa.
- 2 Department of Paediatrics and Child Health , Red Cross War Memorial Children's Hospital, University of Cape Town , Cape Town , South Africa.
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