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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‖††

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2010 - Volume 54 - Issue 1 - p 102-106
doi: 10.1097/QAI.0b013e3181c080bf
Brief Report: Epidemiology and Prevention

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.

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:

© 2010 Lippincott Williams & Wilkins, Inc.