Pilot programme for the rapid initiation of antiretroviral therapy in pregnancy in Cape Town, South Africa

Initiation of antiretroviral therapy (ART) in pregnancy is an important intervention to prevent the mother-to-child transmission (MTCT) of HIV and to promote maternal health. Early initiation of ART is particularly important to achieve viral suppression rapidly before delivery. However, current approaches to start ART in pregnancy may be problematic in many settings, with referrals between antenatal care (ANC) and ART services, and delays for patient preparation before ART initiation. These steps contribute to a sizable proportion of women failing to receive adequate duration of ART before delivery, increasing the risk of MTCT. To address these limitations, we developed the rapid initiation of antiretroviral therapy in pregnancy (RAP) programme. The programme featured the use of point-of-care CD4 testing to identify ART-eligible women with CD4 cell counts ≤ 350 cells/μl; immediate ART initiation in women on the same day that eligibility was determined, if possible; and intensive counselling and support for ART initiation during the first few weeks on ART. We implemented RAP in an antenatal clinic setting in Cape Town South Africa. Between February and August 2011, a total of 221 HIV-infected women were referred to the programme for CD4 cell count testing and 101 (46%) were eligible for ART. Of these, 98 women (97%) started therapy during pregnancy, 89 (91%) on the day of referral to the service. In-depth interviews suggested that although there were substantial challenges facing HIV-infected women initiating ART in pregnancy, the availability of immediate services and counselling support played an important role in addressing these. While further research is needed, this evaluation demonstrates that a novel service delivery approach may facilitate rapid ART initiation in pregnancy

Antiretroviral therapy · Art Therapy · Family medicine · Obstetrics · Physical therapy · Pregnancy · Referral · Service delivery framework · Viral load · Adolescent Sexual and Reproductive Health · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing · Pediatrics

• A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women

  Open Access•Ian Hodgson, Mary L Plummer et al.•PLoS ONE•2014

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• Cost-Effectiveness of a Package of Interventions for Expedited Antiretroviral Therapy Initiation During Pregnancy in Cape Town, South Africa

  Open Access•Rose Zulliger, Samantha Black et al.•AIDS and Behavior•2013

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• Acceptability and challenges of rapid ART initiation among pregnant women in a pilot programme, Cape Town, South Africa

  Samantha Black, Rose Zulliger et al.•AIDS Care•2014

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• The challenge of referring HIV-positive pregnant women with treatment indication from PMTCT to ART services

  Stefanie Theuring, Julius Sewangi et al.•AIDS Care•2014

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• Common Mental Disorders among HIV-Infected Individuals in South Africa

  Landon Myers, Landon Myer et al.•AIDS Patient Care and STDs•2008

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• Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals

  Georgina Spies, K Kader et al.•AIDS Care•2009

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• Prevention of mother-to-child transmission of HIV in Zambia

  Open Access•Justin Mandala, Kwasi Torpey et al.•BMC Public Health•2009

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