Prevention of mother-to-child transmission of HIV in Zambia: implementing efficacious ARV regimens in primary health center
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Date
2009
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Publisher
BMC Public Health
Abstract
Background: Safety and effectiveness of efficacious antiretroviral (ARV) regimens beyond single-dose nevirapine
(sdNVP) for prevention of mother-to-child transmission (PMTCT) have been demonstrated in well-controlled
clinical studies or in secondary- and tertiary-level facilities in developing countries. This paper reports on
implementation of and factors associated with efficacious ARV regimens among HIV-positive pregnant women
attending antenatal clinics in primary health centers (PHCs) in Zambia.
Methods: Blood sample taken for CD4 cell count, availability of CD4 count results, type of ARV prophylaxis for
mothers, and additional PMTCT service data were collected for HIV-positive pregnant women and newborns
who attended 60 PHCs between April 2007 and March 2008.
Results: Of 14,815 HIV-positive pregnant women registered in the 60 PHCs, 2,528 (17.1%) had their CD4 cells
counted; of those, 1,680 (66.5%) had CD4 count results available at PHCs; of those, 796 (47.4%) had CD4 count
d 350 cells/mm3 and thus were eligible for combination antiretroviral treatment (cART); and of those, 581 (73.0%)
were initiated on cART. The proportion of HIV-positive pregnant women whose blood sample was collected for
CD4 cell count was positively associated with (1) blood-draw for CD4 count occurring on the same day as
determination of HIV-positive status; (2) CD4 results sent back to the health facilities within seven days; (3)
facilities without providers trained to offer ART; and (4) urban location of PHC. Initiation of cART among HIV positive pregnant women was associated with the PHC's capacity to provide care and antiretroviral treatment
services. Overall, of the 14,815 HIV-positive pregnant women registered, 10,015 were initiated on any type of
ARV regimen: 581 on cART, 3,041 on short course double ARV regimen, and 6,393 on sdNVP.
Conclusion: Efficacious ARV regimens beyond sdNVP can be implemented in resource-constrained PHCs. The
majority (73.0%) of women identified eligible for ART were initiated on cART; however, a minority (11.3%) of
HIV-positive pregnant women were assessed for CD4 count and had their test results available. Factors
associated with implementation of more efficacious ARV regimens include timing of blood-draw for CD4 count
and capacity to initiate cART onsite where PMTCT services were being offered.
Description
Research Article
Keywords
mother-to-child transmission, HIV, ARV, Zambia