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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3181c080bf
Brief Report: Epidemiology and Prevention

Antiretroviral Treatment Initiation Among HIV-Infected Pregnant Women with Low CD4+ Cell Counts in Gaborone, Botswana

Chen, Jennifer Y MD*; Ogwu, Anthony C MD†; Svab, Petr MD‡; Lockman, Shahin MD, MSc§‖; Moffat, Howard J MBChB, FRCP¶; Gaolathe, Tendani MD#; Moilwa, Shana RN‡; Størdal, Ketil MD, PhD‡; Dryden-Peterson, Scott MD†**; Moffat, Claire MD, MPH†; Makhema, Joseph MBChB†; Essex, M DVM, PhD‖; Shapiro, Roger L MD, MPH‖††

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Abstract

Background: 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.

Methods: From October 2007 through June 2008, we reviewed obstetric and laboratory records of women at Princess Marina Hospital in Gaborone, Botswana.

Results: 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.

Conclusions: 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.

© 2010 Lippincott Williams & Wilkins, Inc.

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