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WEPE184 - Poster Exhibition
Referral of treatment-eligible pregnant women from PMTCT to ART services: a retrospective follow-up study in Mbeya Region, Tanzania
S. Theuring1, J. Sewangi2, P. Mbezi3, P. Nchimbi3, G. Harms1
1Charité - Universitätsmedizin, Institute of Tropical Medicine and International Health, Berlin, Germany, 2Ministry of Health and Social Welfare, Tanzania, Regional AIDS Control Programme, Mbeya, United Republic of Tanzania, 3Ministry of Health and Social Welfare, Tanzania, PMTCT Programme, Mbeya, United Republic of Tanzania
Background: Providing antiretroviral treatment (ART) to all HIV-positive pregnant women with treatment indication could significantly contribute to prevention of mother-to-child transmission (PMTCT). However, low rates of ART initiation during pregnancy and weak linkages between antenatal care (ANC)/PMTCT and Care and Treatment Centers (CTC) are a common problem in resource-limited countries. ART-eligible pregnant women have so far rarely been followed-up to assess the effectiveness of referral between those services.
Methods: A randomly selected cohort of treatment-eligible ANC clients in Mbeya Region, Tanzania was retrospectively followed-up from ANC transfer-in until 6m post-delivery. Data of mother-infant-pairs was retraced in respective registries of ANC, CTC and infant care, using a specific data extraction form to merge obtained information. ART initiation and duration before delivery served as primary outcome indicators.
Results: We followed-up data of 70 ANC clients with confirmed treatment indication (median CD4-count 233 cells/µl/ gestational age 24w at transfer-in) at least until delivery. Thirty-one women (44.3%) started ART before delivery, while 39 (55.7%) remained untreated during pregnancy. Another 31 started ART after delivery, 8 (11.4% of all) did not initiate ART in the observation period. Among women starting treatment in pregnancy, ART was initiated on average 54 days prior delivery. Duration between ANC transfer-in and CTC-enrolment was significantly linked to pre-delivery ART start (p=0.014). From 47 mother-infant-pairs with retraceable delivery data, 11 (23.4%) mothers and 13 (27.7%) infants had received no or inadequate antiretroviral drugs at maternity wards. Within 6m post-delivery, women attended on average 3.5 out of 6 requested CTC visits.
Conclusions: The majority of treatment-eligible women in this cohort were not covered through ART before delivery. Time gaps before ART initiation as well as the intra-and postpartum continuum of care should be targeted. Adequately addressing needs of ART-eligible pregnant women could substantially reduce overall vertical transmission, and more research in this field is urgently required.
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