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

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dc.contributor.authorStinson, Kathrynen_ZA
dc.contributor.authorJennings, Karenen_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.date.accessioned2015-11-18T07:07:01Z
dc.date.available2015-11-18T07:07:01Z
dc.date.issued2013en_ZA
dc.description.abstractObjectives 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.identifier.apacitationStinson, K., Jennings, K., & Myer, L. (2013). Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study. <i>PLoS One</i>, http://hdl.handle.net/11427/15124en_ZA
dc.identifier.chicagocitationStinson, Kathryn, Karen Jennings, and Landon Myer "Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15124en_ZA
dc.identifier.citationStinson, 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.0063328en_ZA
dc.identifier.ris TY - Journal Article AU - Stinson, Kathryn AU - Jennings, Karen AU - Myer, Landon AB - 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. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0063328 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study TI - Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study UR - http://hdl.handle.net/11427/15124 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15124
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0063328
dc.identifier.vancouvercitationStinson K, Jennings K, Myer L. Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study. PLoS One. 2013; http://hdl.handle.net/11427/15124.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_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 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Stinson et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherPregnancyen_ZA
dc.subject.otherAntenatal careen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHealth services researchen_ZA
dc.subject.otherChild healthen_ZA
dc.titleIntegration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: 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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