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Do Targeted HIV Programs Improve Overall Care for Pregnant Women?: Antenatal Syphilis Management in Zambia Before and After Implementation of Prevention of Mother-to-Child HIV Transmission Programs

Potter, Dara MBA, DrPH*†; Goldenberg, Robert L MD*†‡; Chao, Ann MS, MPH, PhD§; Sinkala, Moses MBBA, MPH; Degroot, Alain; Stringer, Jeffrey S A MD*†; Bulterys, Marc MD, PhD§; Vermund, Sten H MD, PhD*†∥

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2008 - Volume 47 - Issue 1 - p 79-85
doi: 10.1097/QAI.0b013e31815d2f71
Epidemiology and Social Science

Background: The implementation of disease-specific research or service programs may have an ancillary beneficial or harmful impact on routine clinical services.

Methods: We reviewed the records of 5801 first visits to 22 antenatal clinics from 1997 to 2004 in Lusaka, Zambia and examined documented syphilis rapid plasma reagin (RPR) screening and syphilis treatment before and after implementation of research and/or service programs in prevention of mother-to-child (PMTCT) HIV transmission.

Findings: Compared with before PMTCT program implementation, the prevalence odds ratios (PORs) and 95% confidence intervals (CIs) for documented RPR screening were 0.9 (0.7 to 1.1) after implementation of research, 0.7 (0.6 to 0.8) after service, and 2.5 (2.1 to 3.0) after research and service programs.

Conclusions: Documented RPR screening was improved after implementation of PMTCT research and service were operating simultaneously and not with research or service alone. Health policy makers and researchers should plan explicitly for how the targeted HIV programs, service, and/or research can have a broader primary care impact.

From the *Schools of Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL; †Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; ‡Drexel University College of Medicine, Philadelphia, PA; §Centers for Disease Control and Prevention, Global AIDS Program, Lusaka, Zambia; and ∥Vanderbilt University School of Medicine, Nashville, TN.

Received for publication August 4, 2007; accepted October 4, 2007.

Supported in part by National Institutes of Health grants 1 F31 HD 046415-01, U01 AI47972-05 (HIV Prevention Trials Network), and D43 TW01035-07 (AIDS International Training and Research Program). Service programs were supported by the Call to Action program of the Elizabeth Glaser Pediatric AIDS Foundation, with added financial support from the US Government, the Mother and Child HIV Prevention Initiative, and the Bill and Melinda Gates Foundation.

Correspondence to: Dara Potter, MBA, DrPH, Centre for Infectious Disease Research in Zambia, 5977 Benekale and Mwembeshi Northmead, Lusaka, Zambia (e-mail: dara.potter@cidrz.org).

© 2008 Lippincott Williams & Wilkins, Inc.