systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of hiv-positive mothers a cohort study系统延迟启动抗逆转录病毒疗法在怀孕期间不能提高艾滋病毒阳性母亲一个队列研究的结果.pdf

Myer et al. BMC Pregnancy and Childbirth 2012, 12:94 /1471-2393/12/94 RESEARCH ARTICLE Open Access Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study 1* 2 3 4 Landon Myer , Rose Zulliger , Linda-Gail Bekker and Elaine Abrams Abstract Background: Antiretroviral therapy (ART) initiation in eligible HIV-infected pregnant women is an important intervention to promote maternal and child health. Increasing the duration of ART received before delivery plays a major role in preventing vertical HIV transmission, but pregnant women across Africa experience significant delays in starting ART, partly due the perceived need to deliver ART counseling and patient education before ART initiation. We examined whether delaying ART to provide pre-ART counseling was associated with improved outcomes among HIV-infected women in Cape Town, South Africa. Methods: We undertook a retrospective cohort study of 490 HIV-infected pregnant women referred to initiate treatment at an urban ART clinic. At this clinic all patients including pregnant women are screened by a clinician and then undergo three sessions of counseling and patient education prior to starting treatment, commonly introducing delays of 2–4 weeks before ART initiation. Data on viral suppression and retention in care after ART initiation were taken from routine clinic records. Results: A total of 382 women initiated ART before delivery (78%); ART initiation before delivery was associated with earlier gestational age at presentation to the ART service (p 0.001). The median delay between screening and ART initiation was 21 days (IQR, 14–29 days). Overall, 84.7%, 79.6% and 75.0% of women who wer