Author:
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Gamell, Anna; Luwanda, Lameck B.; Kalinjuma, Aneth Vedastus; Samson, Leila; Ntamatungiro, Alex J.; Weisser, Maja; Gingo, Winfrid; Tanner, Marcel; Hatz, Christoph; Letang, Emilio; Battegay, Manuel; KIULARCO Study Group
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Abstract:
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BACKGROUND: Strategies to improve the uptake of Prevention of
Mother-To-Child Transmission of HIV (PMTCT) are needed. We
integrated HIV and maternal, newborn and child health services
in a One Stop Clinic to improve the PMTCT cascade in a rural
Tanzanian setting. METHODS: The One Stop Clinic of Ifakara
offers integral care to HIV-infected pregnant women and their
families at one single place and time. All pregnant women and
HIV-exposed infants attended during the first year of Option B+
implementation (04/2014-03/2015) were included. PMTCT was
assessed at the antenatal clinic (ANC), HIV care and labour
ward, and compared with the pre-B+ period. We also characterised
HIV-infected pregnant women and evaluated the MTCT rate.
RESULTS: 1,579 women attended the ANC. Seven (0.4%) were known
to be HIV-infected. Of the remainder, 98.5% (1,548/1,572) were
offered an HIV test, 94% (1,456/1,548) accepted and 38 (2.6%)
tested HIV-positive. 51 were re-screened for HIV during late
pregnancy and one had seroconverted. The HIV prevalence at the
ANC was 3.1% (46/1,463). Of the 39 newly diagnosed women, 35
(90%) were linked to care. HIV test was offered to >98% of
ANC clients during both the pre- and post-B+ periods. During the
post-B+ period, test acceptance (94% versus 90.5%, p<0.0001)
and linkage to care (90% versus 26%, p<0.0001) increased. Ten
additional women diagnosed outside the ANC were linked to care.
82% (37/45) of these newly-enrolled women started antiretroviral
treatment (ART). After a median time of 17 months, 27% (12/45)
were lost to follow-up. 79 women under HIV care became pregnant
and all received ART. After a median follow-up time of 19
months, 6% (5/79) had been lost. 5,727 women delivered at the
hospital, 20% (1,155/5,727) had unknown HIV serostatus. Of
these, 30% (345/1,155) were tested for HIV, and 18/345 (5.2%)
were HIV-positive. Compared to the pre-B+ period more women were
tested during labour (30% versus 2.4%, p<0.0001). During the
study, the MTCT rate was 2.2%. CONCLUSIONS: The implementation
of Option B+ through an integrated service delivery model
resulted in universal HIV testing in the ANC, high rates of
linkage to care, and MTCT below the elimination threshold.
However, HIV testing in late pregnancy and labour, and retention
during early ART need to be improved. |