Comparing two service delivery models for the prevention of mother-to-child transmission PMTCT of HIV during transition from single-dose nevirapine to multi-drug antiretroviral regimensReport as inadecuate




Comparing two service delivery models for the prevention of mother-to-child transmission PMTCT of HIV during transition from single-dose nevirapine to multi-drug antiretroviral regimens - Download this document for free, or read online. Document in PDF available to download.

BMC Public Health

, 10:753

First Online: 06 December 2010Received: 07 June 2010Accepted: 06 December 2010

Abstract

BackgroundMother-to-child transmission MTCT of HIV has been eliminated from the developed world with the introduction of multi-drug antiretroviral md-ARV regimens for the prevention of MTCT PMTCT; but remains the major cause of HIV infection among sub-Saharan African children. This study compares two service delivery models of PMTCT interventions and documents the lessons learned and the challenges encountered during the transition from single-dose nevirapine sd-nvp to md-ARV regimens in a resource-limited setting.

MethodsProgram data collected from 32 clinical sites was used to describe trends and compare the performance uptake of HIV testing, CD4 screening and ARV regimens initiated during pregnancy of sites providing PMTCT as a stand-alone service stand-alone site versus sites providing PMTCT as well as antiretroviral therapy ART full package site. CD4 cell count screening, enrolment into ART services and the initiation of md-ARV regimens during pregnancy, including dual zidovudine AZT +sd-nvp prophylaxis and highly active antiretroviral therapy HAART were analysed.

ResultsFrom July 2006 to December 2008, 1,622 pregnant women tested HIV positive HIV+ during antenatal care ANC. CD4 cell count screening during pregnancy increased from 60% to 70%, and the initiation of md-ARV regimens increased from 35.5% to 97% during this period. In 2008, women attending ANC at full package sites were 30% more likely to undergo CD4 cell count assessment during pregnancy than women attending stand-alone sites relative risk RR = 1.3; 95% confidence interval CI: 1.1-1.4. Enrolment of HIV+ pregnant women in ART services was almost twice as likely at full package sites than at stand-alone sites RR = 1.9; 95% CI: 1.5-2.3. However, no significant differences were detected between the two models of care in providing md-ARV RR = 0.9; 95% CI: 0.9-1.0.

ConclusionsAll sites successfully transitioned from sd-nvp to md-ARV regimens for PMTCT. Full package sites offer the most efficient model for providing immunological assessment and enrolment into care and treatment of HIV+ pregnant women. Strengthening the capacity of stand-alone PMTCT sites to achieve the same objectives is paramount.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-10-753 contains supplementary material, which is available to authorized users.

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Author: Landry Tsague - Fatima Oliveira Tsiouris - Rosalind J Carter - Veronicah Mugisha - Gilbert Tene - Elevanie Nyankesha - Ste

Source: https://link.springer.com/







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