Effectiveness of community-based support for pregnant women living with HIV: a cohort study in South Africa
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Auteurs : Geoffrey Fatti ; Najma Shaikh ; Brian Eley ; Ashraf GrimwoodSource :
- AIDS Care [ 0954-0121 ] ; 2016.
Abstract
Antiretroviral treatment (ART) initiation in HIV-infected pregnant women in sub-Saharan Africa (SSA) remains inadequate, and there is a severe shortage of professional healthcare workers in the region. The effectiveness of community support programmes for HIV-infected pregnant women and their infants in SSA is unclear. This study compared initiation of maternal antiretrovirals and infant outcomes amongst HIV-infected pregnant women and their infants who received and did not receive community-based support (CBS) in a high HIV-prevalence setting in South Africa. A cohort study, including HIV-infected pregnant women and their infants, was conducted at three sentinel surveillance facilities between January 2009 and June 2012, utilising enhanced routine clinical data. Through home visits, CBS workers encouraged uptake of interventions in the ART cascade, provided HIV-related education, ART initiation counselling and psychosocial support. Outcomes were compared using Kaplan–Meier analyses and multivariable Cox and log-binomial regression. Amongst 1105 mother–infant pairs included, 264 (23.9%) received CBS. Amongst women eligible to start ART antenatally, women who received CBS had a reduced risk of not initiating antenatal ART, 5.4% vs. 30.3%; adjusted risk ratio (aRR) = 0.18 (95% CI: 0.08–0.44;
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DOI: 10.1080/09540121.2016.1148112
PubMed: 26922939
PubMed Central: 4828595
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effectiveness of community-based support for pregnant women living with HIV: a cohort study in South Africa<xref ref-type="fn" rid="FN0000"></xref></title><author><name sortKey="Fatti, Geoffrey" sort="Fatti, Geoffrey" uniqKey="Fatti G" first="Geoffrey" last="Fatti">Geoffrey Fatti</name><affiliation><nlm:aff id="AF1"></nlm:aff></affiliation></author><author><name sortKey="Shaikh, Najma" sort="Shaikh, Najma" uniqKey="Shaikh N" first="Najma" last="Shaikh">Najma Shaikh</name><affiliation><nlm:aff id="AF1"></nlm:aff></affiliation></author><author><name sortKey="Eley, Brian" sort="Eley, Brian" uniqKey="Eley B" first="Brian" last="Eley">Brian Eley</name><affiliation><nlm:aff id="AF2"></nlm:aff></affiliation></author><author><name sortKey="Grimwood, Ashraf" sort="Grimwood, Ashraf" uniqKey="Grimwood A" first="Ashraf" last="Grimwood">Ashraf Grimwood</name><affiliation><nlm:aff id="AF1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26922939</idno><idno type="pmc">4828595</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828595</idno><idno type="RBID">PMC:4828595</idno><idno type="doi">10.1080/09540121.2016.1148112</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000317</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000317</idno><idno type="wicri:Area/Pmc/Curation">000317</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000317</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effectiveness of community-based support for pregnant women living with HIV: a cohort study in South Africa<xref ref-type="fn" rid="FN0000"></xref></title><author><name sortKey="Fatti, Geoffrey" sort="Fatti, Geoffrey" uniqKey="Fatti G" first="Geoffrey" last="Fatti">Geoffrey Fatti</name><affiliation><nlm:aff id="AF1"></nlm:aff></affiliation></author><author><name sortKey="Shaikh, Najma" sort="Shaikh, Najma" uniqKey="Shaikh N" first="Najma" last="Shaikh">Najma Shaikh</name><affiliation><nlm:aff id="AF1"></nlm:aff></affiliation></author><author><name sortKey="Eley, Brian" sort="Eley, Brian" uniqKey="Eley B" first="Brian" last="Eley">Brian Eley</name><affiliation><nlm:aff id="AF2"></nlm:aff></affiliation></author><author><name sortKey="Grimwood, Ashraf" sort="Grimwood, Ashraf" uniqKey="Grimwood A" first="Ashraf" last="Grimwood">Ashraf Grimwood</name><affiliation><nlm:aff id="AF1"></nlm:aff></affiliation></author></analytic><series><title level="j">AIDS Care</title><idno type="ISSN">0954-0121</idno><idno type="eISSN">1360-0451</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>ABSTRACT</title><p>Antiretroviral treatment (ART) initiation in HIV-infected pregnant women in sub-Saharan Africa (SSA) remains inadequate, and there is a severe shortage of professional healthcare workers in the region. The effectiveness of community support programmes for HIV-infected pregnant women and their infants in SSA is unclear. This study compared initiation of maternal antiretrovirals and infant outcomes amongst HIV-infected pregnant women and their infants who received and did not receive community-based support (CBS) in a high HIV-prevalence setting in South Africa. A cohort study, including HIV-infected pregnant women and their infants, was conducted at three sentinel surveillance facilities between January 2009 and June 2012, utilising enhanced routine clinical data. Through home visits, CBS workers encouraged uptake of interventions in the ART cascade, provided HIV-related education, ART initiation counselling and psychosocial support. Outcomes were compared using Kaplan–Meier analyses and multivariable Cox and log-binomial regression. Amongst 1105 mother–infant pairs included, 264 (23.9%) received CBS. Amongst women eligible to start ART antenatally, women who received CBS had a reduced risk of not initiating antenatal ART, 5.4% vs. 30.3%; adjusted risk ratio (aRR) = 0.18 (95% CI: 0.08–0.44; <italic>P</italic> < .0001). Women who received CBS initiated antenatal ART with less delay after the first antenatal visit, median 26 days vs. 39 days; adjusted hazard ratio (aHR) = 1.57 (95% CI: 1.15–2.14; <italic>P</italic> = .004). Amongst women who initiated antenatal zidovudine (ZDV) to prevent vertical transmission, women who received CBS initiated ZDV with less delay, aHR = 1.52 (95% CI: 1.18–2.01; <italic>P</italic> = .001). Women who received CBS had a lower risk of stillbirth, 1.5% vs. 5.4%; aRR = 0.24 (95% CI: 0.07–1.00; <italic>P</italic> = .050). Pregnant women living with HIV who received CBS had improved antenatal triple ART initiation in eligible women, women initiated ART and ZDV with shorter delays, and had a lower risk of stillbirth. CBS is an intervention that shows promise in improving maternal and infant health in high HIV-prevalence settings.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Banda, T" uniqKey="Banda T">T. Banda</name></author><author><name sortKey="Pribram, V" uniqKey="Pribram V">V. Pribram</name></author><author><name sortKey="Lawson, M" uniqKey="Lawson M">M. Lawson</name></author><author><name sortKey="Mkangama, C" uniqKey="Mkangama C">C. Mkangama</name></author><author><name sortKey="Nyirenda, G" uniqKey="Nyirenda G">G. Nyirenda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="B Rnighausen, T" uniqKey="B Rnighausen T">T. Bärnighausen</name></author><author><name sortKey="Bloom, D E" uniqKey="Bloom D">D. E. Bloom</name></author><author><name sortKey="Humair, S" uniqKey="Humair S">S. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">AIDS Care</journal-id><journal-id journal-id-type="iso-abbrev">AIDS Care</journal-id><journal-id journal-id-type="archive">CAIC</journal-id><journal-id journal-id-type="publisher-id">caic20</journal-id><journal-title-group><journal-title>AIDS Care</journal-title></journal-title-group><issn pub-type="ppub">0954-0121</issn><issn pub-type="epub">1360-0451</issn><publisher><publisher-name>Taylor & Francis</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26922939</article-id><article-id pub-id-type="pmc">4828595</article-id><article-id pub-id-type="publisher-id">1148112</article-id><article-id pub-id-type="doi">10.1080/09540121.2016.1148112</article-id><article-categories><subj-group subj-group-type="article-type"><subject>Article</subject></subj-group><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Effectiveness of community-based support for pregnant women living with HIV: a cohort study in South Africa<xref ref-type="fn" rid="FN0000"></xref></article-title><fn-group><fn id="FN0000"><p>This article makes reference to supplementary material available on the publisher's website at <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1080/09540121.2016.1148112">http://dx.doi.org/10.1080/09540121.2016.1148112</ext-link></p></fn></fn-group></title-group><contrib-group><contrib contrib-type="author"><name><surname>Fatti</surname><given-names>Geoffrey</given-names></name><xref ref-type="aff" rid="AF1"><sup>a</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Shaikh</surname><given-names>Najma</given-names></name><xref ref-type="aff" rid="AF1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Eley</surname><given-names>Brian</given-names></name><xref ref-type="aff" rid="AF2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Grimwood</surname><given-names>Ashraf</given-names></name><xref ref-type="aff" rid="AF1"><sup>a</sup></xref></contrib><aff id="AF1"><label><sup>a</sup></label><institution><named-content content-type="institution-name">Kheth'Impilo</named-content></institution>,<named-content content-type="city">Cape Town</named-content>,<country>South Africa</country></aff><aff id="AF2"><label><sup>b</sup></label><institution><named-content content-type="department">Department of Paediatrics and Child Health</named-content>,<named-content content-type="institution-name">Red Cross War Memorial Children's Hospital, University of Cape Town</named-content></institution>,<named-content content-type="city">Cape Town</named-content>,<country>South Africa</country></aff></contrib-group><author-notes><corresp id="cor1"><label>CONTACT </label> Geoffrey Fatti <email xlink:href="geoffrey.fatti@khethimpilo.org">geoffrey.fatti@khethimpilo.org</email><institution><named-content content-type="institution-name">Kheth'Impilo</named-content></institution>, <named-content content-type="city">Cape Town</named-content>, <country>South Africa</country></corresp></author-notes><pub-date pub-type="ppub"><day>24</day><month>3</month><year>2016</year><pmc-comment>string-date: March 2016</pmc-comment>
</pub-date><pub-date pub-type="epub"><day>28</day><month>2</month><year>2016</year></pub-date><volume>28</volume><issue>sup1</issue><issue-title>2015 AIDS Impact Conference Supplement</issue-title><fpage seq="20">114</fpage><lpage>118</lpage><history><date date-type="received"><day>30</day><month>9</month><year>2015</year></date><date date-type="accepted"><day>26</day><month>1</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 The Author(s). Published by Taylor & Francis.</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>The Author(s)</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/Licenses/by-nc-nd/4.0/">http://creativecommons.org/Licenses/by-nc-nd/4.0/</ext-link>), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="caic-28-114.pdf"></self-uri><abstract><title>ABSTRACT</title><p>Antiretroviral treatment (ART) initiation in HIV-infected pregnant women in sub-Saharan Africa (SSA) remains inadequate, and there is a severe shortage of professional healthcare workers in the region. The effectiveness of community support programmes for HIV-infected pregnant women and their infants in SSA is unclear. This study compared initiation of maternal antiretrovirals and infant outcomes amongst HIV-infected pregnant women and their infants who received and did not receive community-based support (CBS) in a high HIV-prevalence setting in South Africa. A cohort study, including HIV-infected pregnant women and their infants, was conducted at three sentinel surveillance facilities between January 2009 and June 2012, utilising enhanced routine clinical data. Through home visits, CBS workers encouraged uptake of interventions in the ART cascade, provided HIV-related education, ART initiation counselling and psychosocial support. Outcomes were compared using Kaplan–Meier analyses and multivariable Cox and log-binomial regression. Amongst 1105 mother–infant pairs included, 264 (23.9%) received CBS. Amongst women eligible to start ART antenatally, women who received CBS had a reduced risk of not initiating antenatal ART, 5.4% vs. 30.3%; adjusted risk ratio (aRR) = 0.18 (95% CI: 0.08–0.44; <italic>P</italic> < .0001). Women who received CBS initiated antenatal ART with less delay after the first antenatal visit, median 26 days vs. 39 days; adjusted hazard ratio (aHR) = 1.57 (95% CI: 1.15–2.14; <italic>P</italic> = .004). Amongst women who initiated antenatal zidovudine (ZDV) to prevent vertical transmission, women who received CBS initiated ZDV with less delay, aHR = 1.52 (95% CI: 1.18–2.01; <italic>P</italic> = .001). Women who received CBS had a lower risk of stillbirth, 1.5% vs. 5.4%; aRR = 0.24 (95% CI: 0.07–1.00; <italic>P</italic> = .050). Pregnant women living with HIV who received CBS had improved antenatal triple ART initiation in eligible women, women initiated ART and ZDV with shorter delays, and had a lower risk of stillbirth. CBS is an intervention that shows promise in improving maternal and infant health in high HIV-prevalence settings.</p></abstract><kwd-group kwd-group-type="author"><title>KEYWORDS</title><kwd>Pregnancy</kwd><kwd>prevention of mother-to-child transmission of HIV</kwd><kwd>community-based support</kwd><kwd>lay health workers</kwd><kwd>antiretroviral treatment</kwd><kwd>South Africa</kwd></kwd-group><counts><fig-count count="2"></fig-count><table-count count="1"></table-count><equation-count count="0"></equation-count><ref-count count="16"></ref-count><page-count count="5"></page-count></counts></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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