Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. Dr. Janet M. Turan, associate professor in the department of health care organization and policy at the University of Alabama at Birmingham; UAB alumna Ms. Evelyn C. Interis; and an international team of researchers recently aimed to determine if integration of HIV services into ANC settings improves PMTCT service utilization outcomes.
ANC clinics in rural Kenya were randomized to integrated (six clinics, 569 women) or non-integrated (six clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART); control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression.
Results indicated that HIV care enrollment was higher in intervention compared with control clinics (69 percent versus 36 percent, Odds Ratio [OR] = 3.94, 95 percent Confidence Interval [CI]: 1.14 to 13.63). Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, Hazard Ratio [HR] = 2.20, 95 percent CI: 1.62 to 3.01). Eligible women in the intervention arm were more likely to initiate HAART (40 percent versus 17 percent, OR = 3.22, 95 percent CI: 1.81 to 5.72). Infant testing was more common in the intervention arm (25 percent versus 18 percent), however not statistically different. No significant differences were detected in postnatal service uptake or maternal retention.
Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. The investigators concluded that further improvements in the PMTCT cascade will require additional research and interventions.
“Effects of Antenatal Care and HIV Treatment Integration on Elements of the PMTCT Cascade: Results from the SHAIP Cluster-Randomized Controlled Trial in Kenya” is published online in the May issue of the Journal of Acquired Immune Deficiency Syndromes.