Do targeted HIV programs improve overall care for pregnant women?: Antenatal syphilis management in Zambia before and after implementation of prevention of mother-to-child HIV transmission programs.
BACKGROUND
The implementation of disease-specific research or service programs may have an ancillary beneficial or harmful impact on routine clinical services.


METHODS
We reviewed the records of 5801 first visits to 22 antenatal clinics from 1997 to 2004 in Lusaka, Zambia and examined documented syphilis rapid plasma reagin (RPR) screening and syphilis treatment before and after implementation of research and/or service programs in prevention of mother-to-child (PMTCT) HIV transmission.


RESULTS
Compared with before PMTCT program implementation, the prevalence odds ratios (PORs) and 95% confidence intervals (CIs) for documented RPR screening were 0.9 (0.7 to 1.1) after implementation of research, 0.7 (0.6 to 0.8) after service, and 2.5 (2.1 to 3.0) after research and service programs.


CONCLUSIONS
Documented RPR screening was improved after implementation of PMTCT research and service were operating simultaneously and not with research or service alone. Health policy makers and researchers should plan explicitly for how the targeted HIV programs, service, and/or research can have a broader primary care impact.
Potter
Dara
D
Schools of Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. dara.potter@cidrz.org
Goldenberg
Robert L
RL
Chao
Ann
A
Sinkala
Moses
M
Degroot
Alain
A
Stringer
Jeffrey S A
JS
Bulterys
Marc
M
Vermund
Sten H
SH
D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008427:Maternal Health Services / Q000458:organization & administration*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011314:Preventive Health Services / Q000458:organization & administration*; D013587:Syphilis / Q000150:complications / Q000628:therapy*; D013588:Syphilis Serodiagnosis; D015024:Zambia