Research

Safety, feasibility and efficacy of a rapid ART initiation in pregnancy pilot programme in Cape Town, South Africa

Samantha Black, Rose Zulliger, Landon Myer, Rebecca Marcus, Sharon Jeneker, Reghana Taliep, David Pienaar, Robin Wood, Linda-Gail Bekker

Abstract


Background. Antiretroviral therapy (ART) in pregnancy is a crucial intervention in the prevention of mother-to-child transmission (PMTCT) of HIV. It is recognised that mother-to-child transmission is reduced with each week on ART. However, in most South African settings, ART initiation is delayed owing to slow determination of treatment eligibility and separation of HIV and antenatal care services.

Objective. The rapid initiation of an ART in pregnancy programme is a model of care designed to expedite treatment initiation in ART- eligible pregnant women. This study evaluated the performance of the programme.

Methods. Participants enrolled in the ART programme in the same week as their first ANC visit throughout 2011, and had outcome data available by March 2012. Treatment eligibility was determined or confirmed via point-of-care CD4+ testing. Eligible women were offered ART immediately, with concurrent counselling and safety laboratory blood testing. Women attended until 6 - 8 weeks after delivery. Data were collected from clinical records with infant polymerase chain reaction (PCR) results at 6 weeks.

Results. Of 134 ART-eligible (CD4+ count <350 cells/μl or WHO stage III/IV) pregnant women, 130 (97.0%) started ART, 118 (90.8%) initiating treatment the same day that treatment eligibility was determined. There were no abnormal laboratory blood results or adverse events that required medical intervention. Pre-delivery retention in care and infant mortality were comparable to those in similar settings. Of the 107 pregnancies with PCR outcomes available, there was 1 positive HIV result in an infant (0.9%). Maternal viral load suppression in this mother was not achieved by the time of delivery.

Conclusions. This pilot programme provides evidence that rapid ART initiation in pregnancy is safe, feasible and effective in reducing mother-to-child transmission. Further follow-up is required to monitor long-term outcomes. 


Authors' affiliations

Samantha Black, Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa

Rose Zulliger, Department of Health, Behavior and Society, John Hopkins Bloomberg School of Public Health, Baltimore, United States

Landon Myer, Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town; School of Public Health and Family Medicine, University of Cape Town, South Africa

Rebecca Marcus, Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa

Sharon Jeneker, Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town

Reghana Taliep, Metro District Health Services, Western Cape (Klipfontein Mitchell’s Plain Substructure), Cape Town, South Africa

David Pienaar, Provincial Government of the Western Cape, Cape Town, South Africa

Robin Wood, Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town; Department of Medicine, University of Cape Town, South Africa

Linda-Gail Bekker, Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town; Department of Medicine, University of Cape Town

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Keywords

Pregnancy; antiretroviral therapy; prevention of mother-to-child transmission; PMTCT; treatment initiation; HIV/AIDS

Cite this article

South African Medical Journal 2013;103(8):557-562. DOI:10.7196/SAMJ.6565

Article History

Date submitted: 2012-11-29
Date published: 2013-06-27

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