Botswana has the most comprehensive public program in Africa for providing antiretroviral therapy to treat HIV and prevent mother-to-child transmission (PMTCT). Botswana guidelines prioritize CD4+ cell count testing during pregnancy and initiation of highly active antiretroviral treatment (HAART) for women who qualify for treatment. We analyzed rates of HIV testing, CD4+ cell count testing, and HAART initiation during pregnancy.
From October 2007 through June 2008, we reviewed obstetric and laboratory records of women at Princess Marina Hospital in Gaborone, Botswana.
We recorded information from 3056 women. Of 2675 women eligible for the PMTCT program, 2623 (98%) had a documented HIV status, of whom 793 (30%) were HIV infected. Among women who were treatment naive at pregnancy conception, 397 (59%) had recorded CD4+ cell counts, of whom 62 (16%) had a CD4+ cell count <200 cells per cubic millimeter. Among this subset, 23 (37%) initiated HAART during pregnancy, 26 (42%) received zidovudine prophylaxis, and 13 (21%) received no therapy.
We observed low rates of CD4+ cell count testing and HAART initiation during pregnancy. Antenatal clinics should prioritize CD4+ cell count testing and referral of women who qualify for HAART to maximize benefits of maternal treatment and PMTCT.
From the *Harvard Medical School, Boston, MA; †Botswana Harvard AIDS Institute, Bontleng, Gaborone, Botswana; ‡Princess Marina Hospital, Gaborone, Botswana; §Brigham and Women's Hospital, Infectious Disease Unit, Boston, MA; ∥Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA; ¶Botswana Ministry of Health, Health Inspectorate, Gaborone, Botswana; #Botswana Harvard PEPFAR Master Trainer Program, Gaborone, Botswana; **Infectious Disease Unit, Massachusetts General Hospital, Boston, MA; and ††Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA.
Received for publication June 16, 2009; accepted September 9, 2009.
Supported by Funding from the Doris Duke Charitable Research Foundation, through a Clinical Research Fellowship awarded to J.Y.C.
Presented in part as: Chen JY, Ribaudo H, Ogwu A, Svab P, Wester C, Tumbare E, Moffat H, Makhema J, Essex M, Shapiro RL. Risk factors for adverse pregnancy outcomes among HIV-infected women in Gaborone, Botswana. at the 16th Conference on Retroviruses and Opportunistic Infections, February 8-11, 2009, Montreal, Canada. Abstract 949.
No authors have a commercial or other association that might pose a conflict of interest (eg, pharmaceutical stock ownership, consultancy, advisory board membership, relevant patents, or research funding).
Correspondence to: Roger L. Shapiro, MD, MPH, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215 (e-mail: email@example.com).