Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study

 

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dc.contributor.author Stinson, Kathryn en_ZA
dc.contributor.author Jennings, Karen en_ZA
dc.contributor.author Myer, Landon en_ZA
dc.date.accessioned 2015-11-18T07:07:01Z
dc.date.available 2015-11-18T07:07:01Z
dc.date.issued 2013 en_ZA
dc.identifier.citation Stinson, K., Jennings, K., & Myer, L. (2012). Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study. PloS one, 8(5), e63328. doi:10.1371/journal.pone.0063328 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15124
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0063328
dc.description.abstract Objectives Initiation of antiretroviral therapy (ART) during pregnancy is critical to promote maternal health and prevent mother-to-child HIV transmission (PMTCT). The separation of services for antenatal care (ANC) and ART may hinder antenatal ART initiation. We evaluated ART initiation during pregnancy under different service delivery models in Cape Town, South Africa. METHODS: A retrospective cohort study was conducted using routinely collected clinic data. Three models for ART initiation in pregnancy were evaluated ART ‘integrated’ into ANC, ART located ‘proximal’ to ANC, and ART located some distance away from ANC (‘distal’). Kaplan-Meier methods and Poisson regression were used to examine the association between service delivery model and antenatal ART initiation. RESULTS: Among 14 617 women seeking antenatal care in the three services, 30% were HIV-infected and 17% were eligible for ART based on CD4 cell count <200 cells/µL. A higher proportion of women started ART antenatally in the integrated model compared to the proximal or distal models (55% vs 38% vs 45%, respectively, global p = 0.003). After adjusting for age and gestation at first ANC visit, women who at the integrated service were significantly more likely to initiate ART antenatally (rate ratio 1.33; 95% confidence interval: 1.09-1.64) compared to women attending the distal model; there was no difference between the proximal and distal models in antenatal ART initiation however (p = 0.704). CONCLUSIONS: Integration of ART initiation into ANC is associated with higher levels of ART initiation in pregnancy. This and other forms of service integration may represent a valuable intervention to enhance PMTCT and maternal health. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Pregnancy en_ZA
dc.subject.other Antenatal care en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other HIV en_ZA
dc.subject.other Health services research en_ZA
dc.subject.other Child health en_ZA
dc.title Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2013 Stinson et al 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 Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.