Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study

 

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dc.contributor.author Myer, Landon en_ZA
dc.contributor.author Zulliger, Rose en_ZA
dc.contributor.author Bekker, Linda-Gail en_ZA
dc.contributor.author Abrams, Elaine en_ZA
dc.date.accessioned 2015-11-18T03:54:12Z
dc.date.available 2015-11-18T03:54:12Z
dc.date.issued 2012 en_ZA
dc.identifier.citation Myer, L., Zulliger, R., Bekker, L. G., & Abrams, E. (2012). Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study. BMC pregnancy and childbirth, 12(1), 94. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15057
dc.identifier.uri http://dx.doi.org/10.1186/1471-2393-12-94
dc.description.abstract BACKGROUND: Antiretroviral therapy (ART) initiation in eligible HIV-infected pregnant women is an important intervention to promote maternal and child health. Increasing the duration of ART received before delivery plays a major role in preventing vertical HIV transmission, but pregnant women across Africa experience significant delays in starting ART, partly due the perceived need to deliver ART counseling and patient education before ART initiation. We examined whether delaying ART to provide pre-ART counseling was associated with improved outcomes among HIV-infected women in Cape Town, South Africa. METHODS: We undertook a retrospective cohort study of 490 HIV-infected pregnant women referred to initiate treatment at an urban ART clinic. At this clinic all patients including pregnant women are screened by a clinician and then undergo three sessions of counseling and patient education prior to starting treatment, commonly introducing delays of 2-4weeks before ART initiation. Data on viral suppression and retention in care after ART initiation were taken from routine clinic records. RESULTS: A total of 382 women initiated ART before delivery (78%); ART initiation before delivery was associated with earlier gestational age at presentation to the ART service (p<0.001). The median delay between screening and ART initiation was 21days (IQR, 14-29days). Overall, 84.7%, 79.6% and 75.0% of women who were pregnant at the time of ART initiation were retained in care at 4, 8 and 12months after ART initiation, respectively. Among those retained, 91% were virally suppressed at each follow-up visit. However the delay from screening to ART initiation was not associated with retention in care and/or viral suppression throughout the first year on ART in unadjusted or adjusted analyses. CONCLUSIONS: A substantial proportion of eligible pregnant women referred for ART do not begin treatment before delivery in this setting. Among women who do initiate ART, delaying initiation for patient preparation is not associated with improved maternal outcomes. Given the need to maximize the duration of ART before delivery for prevention of mother-to-child HIV transmission, there is an urgent need for new strategies to help expedite ART initiation in eligible pregnant women. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Pregnancy and Childbirth en_ZA
dc.source.uri http://www.biomedcentral.com/bmcpregnancychildbirth/ en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other Pregnancy en_ZA
dc.subject.other Patient preparation en_ZA
dc.subject.other Prevention of mother-to-child transmission (PMTCT) en_ZA
dc.subject.other HIV/AIDS en_ZA
dc.subject.other South Africa en_ZA
dc.title Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study en_ZA
dc.type Journal Article en_ZA
dc.rights.holder 2012 Myer et al.; licensee BioMed Central Ltd. en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Desmond Tutu HIV Centre en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Myer, L., Zulliger, R., Bekker, L., & Abrams, E. (2012). Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study. <i>BMC Pregnancy and Childbirth</i>, http://hdl.handle.net/11427/15057 en_ZA
dc.identifier.chicagocitation Myer, Landon, Rose Zulliger, Linda-Gail Bekker, and Elaine Abrams "Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study." <i>BMC Pregnancy and Childbirth</i> (2012) http://hdl.handle.net/11427/15057 en_ZA
dc.identifier.vancouvercitation Myer L, Zulliger R, Bekker L, Abrams E. Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study. BMC Pregnancy and Childbirth. 2012; http://hdl.handle.net/11427/15057. en_ZA
dc.identifier.ris TY - Journal Article AU - Myer, Landon AU - Zulliger, Rose AU - Bekker, Linda-Gail AU - Abrams, Elaine AB - BACKGROUND: Antiretroviral therapy (ART) initiation in eligible HIV-infected pregnant women is an important intervention to promote maternal and child health. Increasing the duration of ART received before delivery plays a major role in preventing vertical HIV transmission, but pregnant women across Africa experience significant delays in starting ART, partly due the perceived need to deliver ART counseling and patient education before ART initiation. We examined whether delaying ART to provide pre-ART counseling was associated with improved outcomes among HIV-infected women in Cape Town, South Africa. METHODS: We undertook a retrospective cohort study of 490 HIV-infected pregnant women referred to initiate treatment at an urban ART clinic. At this clinic all patients including pregnant women are screened by a clinician and then undergo three sessions of counseling and patient education prior to starting treatment, commonly introducing delays of 2-4weeks before ART initiation. Data on viral suppression and retention in care after ART initiation were taken from routine clinic records. RESULTS: A total of 382 women initiated ART before delivery (78%); ART initiation before delivery was associated with earlier gestational age at presentation to the ART service (p<0.001). The median delay between screening and ART initiation was 21days (IQR, 14-29days). Overall, 84.7%, 79.6% and 75.0% of women who were pregnant at the time of ART initiation were retained in care at 4, 8 and 12months after ART initiation, respectively. Among those retained, 91% were virally suppressed at each follow-up visit. However the delay from screening to ART initiation was not associated with retention in care and/or viral suppression throughout the first year on ART in unadjusted or adjusted analyses. CONCLUSIONS: A substantial proportion of eligible pregnant women referred for ART do not begin treatment before delivery in this setting. Among women who do initiate ART, delaying initiation for patient preparation is not associated with improved maternal outcomes. Given the need to maximize the duration of ART before delivery for prevention of mother-to-child HIV transmission, there is an urgent need for new strategies to help expedite ART initiation in eligible pregnant women. DA - 2012 DB - OpenUCT DO - 10.1186/1471-2393-12-94 DP - University of Cape Town J1 - BMC Pregnancy and Childbirth LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study TI - Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study UR - http://hdl.handle.net/11427/15057 ER - en_ZA


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