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Improved Detection of Incident HIV Infection and Uptake of PMTCT Services in Labor and Delivery in a High HIV Prevalence Setting

Kieffer, Mary Pat MSc*; Nhlabatsi, Bonisile RN; Mahdi, Mohammed MD, MPH*; Hoffman, Heather J PhD; Kudiabor, Kwashie MPH*; Wilfert, Catherine M MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2011 - Volume 57 - Issue 4 - p e85-e91
doi: 10.1097/QAI.0b013e31821acc6e
Implementation and Operational Research: Epidemiology and Prevention

Objective: To maximize prevention of mother-to-child transmission of HIV (PMTCT) effectiveness and increase identification of HIV status in maternity units in Swaziland.

Design: With a quasi-experimental design, 3 maternity units were randomly assigned to the training intervention and 3 units were controls.

Methods: Targeted on-site training was provided to nurse-midwives in intervention sites. HIV status was recorded with testing offered to women presenting with unknown and distant negative status. Cord blood was obtained and tested for HIV antibodies and presence of nevirapine as a marker of PMTCT intervention coverage. Contingency tables and χ2 tests were used to test for associations between frequencies of events.

Results: Of the 2444 enrolled women, 215 (9%) arrived in maternity with unknown status and 1398 (58%) had tested HIV negative in antenatal clinic. Significantly more HIV-negative women (45%) and women with unknown status (96%) in intervention sites were tested compared with similar women in control sites, 14% and 65%, respectively (P < 0.0001 for both). Nevirapine coverage in HIV-positive cord blood was significantly higher in intervention sites (80%) than in control sites (69%, P < 0.0001). Cumulative HIV incidence was 4% with an incidence rate of 16.8 per 100 person-years. Antiretroviral prophylaxis coverage in seroconverters was significantly higher in intervention sites 54% (13 of 24) than the control group [26% (9 of 34), P = 0.03].

Conclusions: In high HIV prevalence settings, such as Swaziland, the incidence of HIV during pregnancy is high. An on-site training intervention for maternity nurses significantly increases the identification of HIV infection and maximizes the provision of PMTCT interventions.

From the *Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Swaziland; †Sexual and Reproductive Health Unit and Ministry of Health, Mbabane, Swaziland; and ‡Department of Epidemiology and Biostatistics, George Washington University School of Public Health & Health Services, Washington, DC.

Received for publication November 29, 2010; accepted March 16, 2011.

Supported by the Elizabeth Glaser Pediatric AIDS Foundation; The Bill and Melinda Gates Foundation.

Kieffer MP, Nhlabatsi B, Mahdi M, et al. Repeat HIV testing in labor and delivery as a standard of care increases ARV provision for women who seroconvert during pregnancy. Data Partially Presented at: 17th Conference on Retroviruses and Opportunistic Infections (CROI); February 16-19, 2010; San Francisco, CA. Oral presentation, Abstract T-180.

Kieffer MP, Nhlabatsi B, Mahdi M, et al. Addressing missed opportunities for PMTCT in maternity reduces perinatal HIV transmission in Swaziland: preliminary study results show increases in ARV access and uptake. 5th Conference on HIV Pathogenesis, Treatment and Prevention; 19-23, July 2009; Cape Town, South Africa. Abstract TUPEC051.

The authors have no conflicts of interest to disclose.

Correspondence to: Mary Pat Kieffer, MSc, Elizabeth Glaser Pediatric AIDS Foundation, PO Box A507, Swazi Plaza, Mbabane, Swaziland (e-mail: mpkieffer@pedaids.org).

© 2011 Lippincott Williams & Wilkins, Inc.