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Universal ART for pregnant women with HIV improves treatment coverage in Swaziland

BOSTON — Switching from a program that only provided ART treatment to eligible pregnant women to a program that provided universal ART helped increase treatment initiation and antenatal retention in Swaziland, according to data presented at CROI 2016.

“In considering whether to move from Option A, where only ART-eligible women receive treatment, to Option B+, where every woman gets lifelong ART, the Ministry of Health had a number of questions around visibility, acceptability … and whether it would be cost-effective,” Harriet Nuwagaba-Biribonwoha, MD, PhD, associate research scientist, International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University Mailman School of Public Health, said during a press conference. “Over a 12-month period … facilities moved from Option A to Option B+. … And the ART initiation was much higher under Option B+.”

Harriet Nuwagaba-Biribonwoha

The researchers used a stepped-wedge design to compare maternal retention under Option A with retention under Option B+ by introducing universal treatment at 10 primary care centers across Swaziland. The program enrolled all pregnant women with HIV infection, who were not currently receiving treatment, upon their first antenatal visit to one of the study centers. The researchers followed participants through 6 months after giving birth via routine health records.

Study results showed that the proportion of women receiving ART treatment increased from 30% before the switch, to 93% afterward (P < .001). Likewise, the proportion of women with a CD4 count less than 350 cells/µL who initiated ART treatment also increased from 63% to 94% (P < .001).

The researchers found that among all HIV-infected women, postnatal retention was higher under Option B+ (P < .001). However, postnatal retention was actually slightly lower when the analysis was restricted to exclusively women on ART treatment (P < .001).

“Overall, we had great success starting women on ART, but we had a great challenge retaining the women, especially after they had their baby,” Nuwagaba-Biribonwoha said. “The government has moved to providing ART more broadly with option B+, and we are conducting additional studies to investigate why the women were lost and where they are.” – by David Costill 

Reference:
Abrams EJ, et al. Abstract 34. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: The researchers report no relevant financial disclosures.