+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Implementation and Operational Research: Effects of Antenatal Care and HIV Treatment Integration on Elements of the PMTCT Cascade: Results From the SHAIP Cluster-Randomized Controlled Trial in Kenya



Implementation and Operational Research: Effects of Antenatal Care and HIV Treatment Integration on Elements of the PMTCT Cascade: Results From the SHAIP Cluster-Randomized Controlled Trial in Kenya



Journal of Acquired Immune Deficiency Syndromes 69(5): E172-E181



Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. This study aimed to determine whether integration of HIV services into ANC settings improves PMTCT service utilization outcomes. ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or nonintegrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), whereas control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. HIV care enrollment was higher in intervention compared with control clinics [69% versus 36%; odds ratio = 3.94, 95% confidence interval (CI): 1.14 to 13.63]. Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, hazard ratio = 2.20, 95% CI: 1.62 to 3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%; odds ratio = 3.22, 95% CI: 1.81 to 5.72). Infant testing was more common in the intervention arm (25% versus 18%), however, not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 058067003

Download citation: RISBibTeXText

PMID: 25967269

DOI: 10.1097/QAI.0000000000000678


Related references

Implementation and Operational Research: Effect of Integration of HIV Care and Treatment Into Antenatal Care Clinics on Mother-to-Child HIV Transmission and Maternal Outcomes in Nyanza, Kenya: Results From the SHAIP Cluster Randomized Controlled Trial. Journal of Acquired Immune Deficiency Syndromes 69(5): E164-E171, 2015

Implementation and Operational Research: Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial. Journal of Acquired Immune Deficiency Syndromes 72(3): E68-E76, 2017

The study of HIV and antenatal care integration in pregnancy in Kenya: design, methods, and baseline results of a cluster-randomized controlled trial. Plos One 7(9): E44181, 2013

Implementation and operational research: the impact of option B+ on the antenatal PMTCT cascade in Lilongwe, Malawi. Journal of Acquired Immune Deficiency Syndromes 68(5): E77-E83, 2015

Integration of family planning services into HIV care clinics: Results one year after a cluster randomized controlled trial in Kenya. Plos One 12(3): E0172992, 2017

Evaluation of a community health worker intervention and the World Health Organization's Option B versus Option A to improve antenatal care and PMTCT outcomes in Dar es Salaam, Tanzania: study protocol for a cluster-randomized controlled health systems implementation trial. Trials 15: 359, 2015

Implementation and Operational Research: Integration of PMTCT and Antenatal Services Improves Combination Antiretroviral Therapy Uptake for HIV-Positive Pregnant Women in Southern Zambia: A Prototype for Option B+?. Journal of Acquired Immune Deficiency Syndromes 70(4): E123-E129, 2016

Implementation of evidence-based antenatal care in Mozambique: a cluster randomized controlled trial: study protocol. Bmc Health Services Research 14: 228, 2015

Promoting male involvement to improve PMTCT uptake and reduce antenatal HIV infection: a cluster randomized controlled trial protocol. Bmc Public Health 11: 778, 2012

Group versus individual antenatal and first year postpartum care: Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria. Gates Open Research 2: 56, 2019

Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial. Aids 27 Suppl 1: S77-S85, 2014

Care cascade structural intervention versus standard of care in the diagnosis and treatment of HIV in China: a cluster-randomized controlled trial protocol. Bmc Health Services Research 17(1): 397, 2018

Implementation and Operational Research: Reconstructing the PMTCT Cascade Using Cross-sectional Household Survey Data: The PEARL Study. Journal of Acquired Immune Deficiency Syndromes 70(1): E5-E9, 2015

Effects of two guideline implementation strategies on patient outcomes in primary care: a cluster randomized controlled trial. Spine 33(5): 473-480, 2008

Impact of Facility-Based Mother Support Groups on Retention in Care and PMTCT Outcomes in Rural Zimbabwe: The EPAZ Cluster-Randomized Controlled Trial. Journal of Acquired Immune Deficiency Syndromes 75 Suppl 2: S207-S215, 2017