Differentiated models of care for postpartum women on antiretroviral therapy in Cape Town, South Africa: a cohort study.
Identifieur interne : 000730 ( PubMed/Checkpoint ); précédent : 000729; suivant : 000731Differentiated models of care for postpartum women on antiretroviral therapy in Cape Town, South Africa: a cohort study.
Auteurs : Landon Myer [Afrique du Sud] ; Victoria Iyun [Afrique du Sud] ; Allison Zerbe [États-Unis] ; Tamsin K. Phillips [Afrique du Sud] ; Kirsty Brittain [Afrique du Sud] ; Elton Mukonda [Afrique du Sud] ; Joanna Allerton [Afrique du Sud] ; Cathy D. Kalombo [Afrique du Sud] ; Andile Nofemela [Afrique du Sud] ; Elaine J. Abrams [États-Unis]Source :
- Journal of the International AIDS Society [ 1758-2652 ] ; 2017.
Abstract
The numbers of women initiating lifelong antiretroviral therapy (ART) during pregnancy and postpartum is increasing rapidly, presenting a burden on health systems and an urgent need for scalable models of care for this population. In a pilot project, we referred postpartum women who initiated ART during pregnancy to a community-based model of differentiated ART services.
DOI: 10.7448/IAS.20.5.21636
PubMed: 28770593
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Differentiated models of care for postpartum women on antiretroviral therapy in Cape Town, South Africa: a cohort study.</title><author><name sortKey="Myer, Landon" sort="Myer, Landon" uniqKey="Myer L" first="Landon" last="Myer">Landon Myer</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Iyun, Victoria" sort="Iyun, Victoria" uniqKey="Iyun V" first="Victoria" last="Iyun">Victoria Iyun</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Zerbe, Allison" sort="Zerbe, Allison" uniqKey="Zerbe A" first="Allison" last="Zerbe">Allison Zerbe</name><affiliation wicri:level="4"><nlm:affiliation>ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>ICAP, Mailman School of Public Health, Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="Phillips, Tamsin K" sort="Phillips, Tamsin K" uniqKey="Phillips T" first="Tamsin K" last="Phillips">Tamsin K. 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Kalombo</name><affiliation wicri:level="1"><nlm:affiliation>Provincial Government of the Western Cape, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Provincial Government of the Western Cape, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Nofemela, Andile" sort="Nofemela, Andile" uniqKey="Nofemela A" first="Andile" last="Nofemela">Andile Nofemela</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J" last="Abrams">Elaine J. 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Phillips</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Brittain, Kirsty" sort="Brittain, Kirsty" uniqKey="Brittain K" first="Kirsty" last="Brittain">Kirsty Brittain</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Mukonda, Elton" sort="Mukonda, Elton" uniqKey="Mukonda E" first="Elton" last="Mukonda">Elton Mukonda</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Allerton, Joanna" sort="Allerton, Joanna" uniqKey="Allerton J" first="Joanna" last="Allerton">Joanna Allerton</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Kalombo, Cathy D" sort="Kalombo, Cathy D" uniqKey="Kalombo C" first="Cathy D" last="Kalombo">Cathy D. Kalombo</name><affiliation wicri:level="1"><nlm:affiliation>Provincial Government of the Western Cape, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Provincial Government of the Western Cape, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Nofemela, Andile" sort="Nofemela, Andile" uniqKey="Nofemela A" first="Andile" last="Nofemela">Andile Nofemela</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J" last="Abrams">Elaine J. Abrams</name><affiliation wicri:level="4"><nlm:affiliation>ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>ICAP, Mailman School of Public Health, Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author></analytic><series><title level="j">Journal of the International AIDS Society</title><idno type="eISSN">1758-2652</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The numbers of women initiating lifelong antiretroviral therapy (ART) during pregnancy and postpartum is increasing rapidly, presenting a burden on health systems and an urgent need for scalable models of care for this population. In a pilot project, we referred postpartum women who initiated ART during pregnancy to a community-based model of differentiated ART services.</div></front></TEI><pubmed><MedlineCitation Status="In-Process" Owner="NLM"><PMID Version="1">28770593</PMID><DateCreated><Year>2017</Year><Month>08</Month><Day>03</Day></DateCreated><DateRevised><Year>2017</Year><Month>09</Month><Day>27</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1758-2652</ISSN><JournalIssue CitedMedium="Internet"><Volume>20</Volume><Issue>Suppl 4</Issue><PubDate><Year>2017</Year><Month>07</Month><Day>21</Day></PubDate></JournalIssue><Title>Journal of the International AIDS Society</Title><ISOAbbreviation>J Int AIDS Soc</ISOAbbreviation></Journal><ArticleTitle>Differentiated models of care for postpartum women on antiretroviral therapy in Cape Town, South Africa: a cohort study.</ArticleTitle><Pagination><MedlinePgn>21636</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.7448/IAS.20.5.21636</ELocationID><Abstract><AbstractText Label="BACKGROUND">The numbers of women initiating lifelong antiretroviral therapy (ART) during pregnancy and postpartum is increasing rapidly, presenting a burden on health systems and an urgent need for scalable models of care for this population. In a pilot project, we referred postpartum women who initiated ART during pregnancy to a community-based model of differentiated ART services.</AbstractText><AbstractText Label="METHODS">Eligible women (on ART for at least 3 months with viral load (VL)<1000 copies/mL) were offered a choice of two ART models of care: (i) referral to an existing system of community-based 'adherence clubs', operated by lay counsellors with medication collection every 2-4 months; or (ii) referral to local primary healthcare clinics (PHC) with services provided by clinicians and medication collection every 1-2 months (local standard of care for postpartum ART). For evaluation, women were followed through 6-months postpartum with VL testing separate from either ART service.</AbstractText><AbstractText Label="RESULTS">Through September 2015, n = 129 women were enrolled (median age, 28 years; median time postpartum, 10 days). Overall, 65% (n = 84) chose adherence clubs and 35% (n = 45) chose PHCs; there were no demographic or clinical predictors of this choice. Location of service delivery was commonly cited as a reason for choice by women selecting either model of care; shorter waiting times, ability to receive ART from lay counsellors and less frequent appointments were motivations for choosing adherence clubs. Among women choosing adherence clubs, 15% never attended the service and another 11% attended the service but were not retained through six months postpartum. Overall, 86% of women (n = 111) remained in the evaluation through 6 months postpartum; in this group, there were no differences in VL<1000 copies/mL at six months postpartum between women choosing PHCs (88%) vs. adherence clubs (92%; p = 0.483), but women who were not retained in adherence clubs were more likely to have VL≥1000 copies/mL compared to those who remained (p = 0.002).</AbstractText><AbstractText Label="DISCUSSION">Adherence clubs may be a valuable model for postpartum women initiating ART in pregnancy, with good short-term outcomes observed during this critical period. To support optimal implementation, further research is needed into patient preferences for models of care, with consideration of integration of maternal and child health services, while ART adherence and retention require ongoing consideration in this population.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Myer</LastName><ForeName>Landon</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Iyun</LastName><ForeName>Victoria</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zerbe</LastName><ForeName>Allison</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Phillips</LastName><ForeName>Tamsin K</ForeName><Initials>TK</Initials><AffiliationInfo><Affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Brittain</LastName><ForeName>Kirsty</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mukonda</LastName><ForeName>Elton</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Allerton</LastName><ForeName>Joanna</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kalombo</LastName><ForeName>Cathy D</ForeName><Initials>CD</Initials><AffiliationInfo><Affiliation>Provincial Government of the Western Cape, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nofemela</LastName><ForeName>Andile</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Abrams</LastName><ForeName>Elaine J</ForeName><Initials>EJ</Initials><AffiliationInfo><Affiliation>ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>College of Physicians & Surgeons, Columbia University, New York, NY, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>R01HD074558</GrantID><Agency>National Institute of Child Health and Human Development (NICHD)</Agency><Country>International</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>J Int AIDS Soc</MedlineTA><NlmUniqueID>101478566</NlmUniqueID><ISSNLinking>1758-2652</ISSNLinking></MedlineJournalInfo><CommentsCorrectionsList><CommentsCorrections RefType="Cites"><RefSource>AIDS Res Treat. 2014;2014:137545</RefSource><PMID Version="1">25548659</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>AIDS Res Treat. 2013;2013:937456</RefSource><PMID Version="1">23956849</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Curr Opin HIV AIDS. 2013 Sep;8(5):474-89</RefSource><PMID Version="1">23925003</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Acquir Immune Defic Syndr. 2015 Nov 1;70(3):e102-9</RefSource><PMID Version="1">26470033</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Acquir Immune Defic Syndr. 2016 Jan 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2:S189-96</RefSource><PMID Version="1">27355508</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Curr Opin HIV AIDS. 2013 Sep;8(5):498-503</RefSource><PMID Version="1">23872611</PMID></CommentsCorrections></CommentsCorrectionsList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">HIV</Keyword><Keyword MajorTopicYN="Y">South Africa</Keyword><Keyword MajorTopicYN="Y">adherence club</Keyword><Keyword MajorTopicYN="Y">antiretroviral therapy</Keyword><Keyword MajorTopicYN="Y">maternal and child health</Keyword><Keyword MajorTopicYN="Y">postnatal care</Keyword></KeywordList><CoiStatement>None of the authors have any competing interests to declare.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>8</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>8</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>8</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28770593</ArticleId><ArticleId IdType="doi">10.7448/IAS.20.5.21636</ArticleId><ArticleId IdType="pmc">PMC5577773</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Afrique du Sud</li><li>États-Unis</li></country><region><li>État de New York</li></region><settlement><li>New York</li></settlement><orgName><li>Université Columbia</li></orgName></list><tree><country name="Afrique du Sud"><noRegion><name sortKey="Myer, Landon" sort="Myer, Landon" uniqKey="Myer L" first="Landon" last="Myer">Landon Myer</name></noRegion><name sortKey="Allerton, Joanna" sort="Allerton, Joanna" uniqKey="Allerton J" first="Joanna" last="Allerton">Joanna Allerton</name><name sortKey="Brittain, Kirsty" sort="Brittain, Kirsty" uniqKey="Brittain K" first="Kirsty" last="Brittain">Kirsty Brittain</name><name sortKey="Iyun, Victoria" sort="Iyun, Victoria" uniqKey="Iyun V" first="Victoria" last="Iyun">Victoria Iyun</name><name sortKey="Kalombo, Cathy D" sort="Kalombo, Cathy D" uniqKey="Kalombo C" first="Cathy D" last="Kalombo">Cathy D. Kalombo</name><name sortKey="Mukonda, Elton" sort="Mukonda, Elton" uniqKey="Mukonda E" first="Elton" last="Mukonda">Elton Mukonda</name><name sortKey="Nofemela, Andile" sort="Nofemela, Andile" uniqKey="Nofemela A" first="Andile" last="Nofemela">Andile Nofemela</name><name sortKey="Phillips, Tamsin K" sort="Phillips, Tamsin K" uniqKey="Phillips T" first="Tamsin K" last="Phillips">Tamsin K. Phillips</name></country><country name="États-Unis"><region name="État de New York"><name sortKey="Zerbe, Allison" sort="Zerbe, Allison" uniqKey="Zerbe A" first="Allison" last="Zerbe">Allison Zerbe</name></region><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J" last="Abrams">Elaine J. Abrams</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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