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

dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorZulliger, Roseen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorAbrams, Elaineen_ZA
dc.date.accessioned2015-11-18T03:54:12Z
dc.date.available2015-11-18T03:54:12Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND: 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.identifier.apacitationMyer, 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/11427/15057en_ZA
dc.identifier.chicagocitationMyer, 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/11427/15057en_ZA
dc.identifier.citationMyer, 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.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
dc.identifier.urihttp://hdl.handle.net/11427/15057
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2393-12-94
dc.identifier.vancouvercitationMyer 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.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2012 Myer et al.; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Pregnancy and Childbirthen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpregnancychildbirth/en_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherPregnancyen_ZA
dc.subject.otherPatient preparationen_ZA
dc.subject.otherPrevention of mother-to-child transmission (PMTCT)en_ZA
dc.subject.otherHIV/AIDSen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleSystemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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