Sierra Washington1, Kevin Owuor, Janet M Turan, Rachel L Steinfeld, Maricianah Onono, Starley B Shade, Elizabeth A Bukusi, Marta L Ackers, Craig R Cohen. 1. *Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, New York, NY; †Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya; ‡Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL; Departments of §Obstetrics, Gynecology, and Reproductive Sciences; ‖Medicine, University of California, San Francisco (UCSF), San Francisco, CA; and ¶US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, GA.
Abstract
BACKGROUND:Many HIV-infected pregnant women identified during antenatal care (ANC) do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants. METHODS: We performed a cluster randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, prevention of mother-to-child transmission, and HIV care delivered in the ANC clinic; n = 6 intervention facilities) or standard ANC services (including prevention of mother-to-child transmission and referral to a separate clinic for HIV care; n = 6 control facilities). RESULTS: There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was 12-month follow-up data for 256 of 611 (41.8%) women and postpartum data for only 325 of 1172 (28%) women. By 9 months of age, 382 of 568 (67.3%) infants at intervention sites and 338 of 594 (57.0%) at control sites had tested for HIV [odds ratio (OR) 1.45, 95% confidence interval (CI): 0.71 to 2.82]; 7.3% of infants tested HIV positive at intervention sites compared with 8.0% of infants at control sites (OR 0.89, 95% CI: 0.56 to 1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1%, OR 0.83, 95% CI: 0.41 to 1.68). CONCLUSIONS: Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk of HIV transmission to infants and did not appear to affect short-term maternal health outcomes.
RCT Entities:
BACKGROUND: Many HIV-infected pregnant women identified during antenatal care (ANC) do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants. METHODS: We performed a cluster randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, prevention of mother-to-child transmission, and HIV care delivered in the ANC clinic; n = 6 intervention facilities) or standard ANC services (including prevention of mother-to-child transmission and referral to a separate clinic for HIV care; n = 6 control facilities). RESULTS: There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was 12-month follow-up data for 256 of 611 (41.8%) women and postpartum data for only 325 of 1172 (28%) women. By 9 months of age, 382 of 568 (67.3%) infants at intervention sites and 338 of 594 (57.0%) at control sites had tested for HIV [odds ratio (OR) 1.45, 95% confidence interval (CI): 0.71 to 2.82]; 7.3% of infants tested HIV positive at intervention sites compared with 8.0% of infants at control sites (OR 0.89, 95% CI: 0.56 to 1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1%, OR 0.83, 95% CI: 0.41 to 1.68). CONCLUSIONS: Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk of HIV transmission to infants and did not appear to affect short-term maternal health outcomes.
Authors: Baotran N Vo; Craig R Cohen; Rachel M Smith; Elizabeth A Bukusi; Maricianah A Onono; Katie Schwartz; Sierra Washington; Janet M Turan Journal: AIDS Care Date: 2012-02-01
Authors: Jeffrey Sa Stringer; Moses Sinkala; Courtney C Maclean; Jens Levy; Chipepo Kankasa; Alain Degroot; Elizabeth M Stringer; Edward P Acosta; Robert L Goldenberg; Sten H Vermund Journal: AIDS Date: 2005-08-12 Impact factor: 4.177
Authors: Mary Glenn Fowler; Margaret A Lampe; Denise J Jamieson; Athena P Kourtis; Martha F Rogers Journal: Am J Obstet Gynecol Date: 2007-09 Impact factor: 8.661
Authors: James Pfeiffer; Pablo Montoya; Alberto J Baptista; Marina Karagianis; Marilia de Morais Pugas; Mark Micek; Wendy Johnson; Kenneth Sherr; Sarah Gimbel; Shelagh Baird; Barrot Lambdin; Stephen Gloyd Journal: J Int AIDS Soc Date: 2010-01-20 Impact factor: 5.396
Authors: Barrot H Lambdin; Mark A Micek; Kenneth Sherr; Sarah Gimbel; Marina Karagianis; Joseph Lara; Stephen S Gloyd; James Pfeiffer Journal: J Acquir Immune Defic Syndr Date: 2013-04-15 Impact factor: 3.731
Authors: Katelyn A Pastick; Elizabeth Nalintya; Lillian Tugume; Kenneth Ssebambulidde; Nicole Stephens; Emily E Evans; Jane Frances Ndyetukira; Edwin Nuwagira; Caleb Skipper; Conrad Muzoora; David B Meya; Joshua Rhein; David R Boulware; Radha Rajasingham Journal: Med Mycol Date: 2020-04-01 Impact factor: 4.076
Authors: Jayleen K L Gunn; Ibitola O Asaolu; Katherine E Center; Steven J Gibson; Patrick Wightman; Echezona E Ezeanolue; John E Ehiri Journal: J Int AIDS Soc Date: 2016-01-18 Impact factor: 5.396
Authors: Seble G Kassaye; John Ong'ech; Martin Sirengo; Judith Kose; Lucy Matu; Peter McOdida; Rogers Simiyu; Titus Syengo; David Muthama; Rhoderick Machekano Journal: AIDS Res Treat Date: 2016-12-08
Authors: McKenna C Eastment; John Kinuthia; Lei Wang; George Wanje; Katherine Wilson; Anne Kaggiah; Jane M Simoni; Kishorchandra Mandaliya; Danielle N Poole; Barbra A Richardson; Walter Jaoko; Grace John-Stewart; R Scott McClelland Journal: PLoS One Date: 2021-07-19 Impact factor: 3.240