Evolution of antiretroviral therapy services for HIV-infected pregnant women in Cape Town, South Africa.
Evolution of antiretroviral therapy services for HIV-infected pregnant women in Cape Town, South Africa.
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DOI：
10.1097/qai.0000000000000584
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发表时间：
2015-06
期刊：
影响因子：
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通讯作者：
Abrams EJ
中科院分区：
文献类型：
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作者：
Myer L;Phillips T;Manuelli V;McIntyre J;Bekker LG;Abrams EJ
近年来，对感染艾滋病毒的孕妇进行抗逆转录病毒治疗的方法发生了很大变化，但关于不同服务提供模式的执行情况的比较数据很少。使用常规诊所记录，我们检查了2010年1月至2013年12月期间在南非开普敦参加大型产前护理（ANC）设施的孕妇的ART启动情况。在此期间，先后实施了六种不同的服务提供模式，在怀孕期间提供抗逆转录病毒治疗，包括将抗逆转录病毒治疗纳入产前护理，使用护理点CD4细胞计数检测，以及为所有感染艾滋病毒的孕妇普遍开始抗逆转录病毒治疗。在研究期间，19 432名妇女寻求产前护理，艾滋病毒检测水平很高（98%），30%的孕妇艾滋病毒检测呈阳性。与转诊到单独的ART诊所相比，将ART纳入ANC与合格妇女在分娩前开始治疗的比例显著增加相关（p<0.001）。当使用CD4细胞计数来确定ART资格时，与基于实验室的测试相比，床旁检测与减少ART启动延迟相关（p<0.001）。普及抗逆转录病毒疗法战略导致抗逆转录病毒疗法启动率最高（92%的妇女在分娩前开始），延迟时间最短，82%的妇女在首次产前保健就诊当天开始抗逆转录病毒疗法。服务提供模式的发展，最显著的是服务一体化和孕妇普遍接受抗逆转录病毒疗法，大大改善了这种情况下产前抗逆转录病毒疗法的启动。需要进一步研究产前抗逆转录病毒疗法启动战略如何长期影响孕产妇和儿童健康。
Approaches to antiretroviral therapy (ART) in HIV-infected pregnant women have changed considerably in recent years, but there are few comparative data on the implementation of different models of service delivery. Using routine clinic records we examined ART initiation in pregnant women attending a large antenatal care (ANC) facility between January 2010 and December 2013 in Cape Town, South Africa. Over this time six different service delivery models were implemented sequentially to provide ART in pregnancy, including the integration of ART into ANC, use of point-of-care CD4 cell count testing, and universal ART initiation for all HIV-infected pregnant women. During the study period 19,432 women sought ANC, levels of HIV testing were high (98%) and 30% of pregnant women tested HIV-positive. Integration of ART into ANC was associated with significant increases in the proportion of eligible women initiating treatment before delivery compared to referral to a separate ART clinic (p<0.001). When CD4 cell counts were used to determine ART eligibility, point-of-care testing was associated with decreased delays to ART initiation compared to laboratory-based testing (p<0.001). The strategy of universal ART led to the highest levels of ART initiation (with 92% of women starting before delivery) and the shortest delays, with 82% of women starting ART on the day of the first ANC visit. Developments in service delivery models, most notably service integration and universal ART for pregnant women, have improved antenatal ART initiation dramatically in this setting. Further research is needed into how strategies for antenatal ART initiation impact maternal and child health over the long-term.