title: Safety, feasibility and efficacy of a rapid ART initiation in pregnancy pilot programme in Cape Town, South Africa.
abstract: BACKGROUND
  Antiretroviral therapy (ART) in pregnancy is a crucial intervention in the prevention of mother-to-child transmission (PMTCT) of HIV. It is recognised that mother-to-child transmission is reduced with each week on ART. However, in most South African settings, ART initiation is delayed owing to slow determination of treatment eligibility and separation of HIV and antenatal care services.
  
  
  OBJECTIVE
  The rapid initiation of an ART in pregnancy programme is a model of care designed to expedite treatment initiation in ART- eligible pregnant women. This study evaluated the performance of the programme.
  
  
  METHODS
  Participants enrolled in the ART programme in the same week as their first ANC visit throughout 2011, and had outcome data available by March 2012. Treatment eligibility was determined or confirmed via point-of-care CD4+ testing. Eligible women were offered ART immediately, with concurrent counselling and safety laboratory blood testing. Women attended until 6 - 8 weeks after delivery. Data were collected from clinical records with infant polymerase chain reaction (PCR) results at 6 weeks.
  
  
  RESULTS
  Of 134 ART-eligible (CD4+ count <350 cells/μl or WHO stage III/IV) pregnant women, 130 (97.0%) started ART, 118 (90.8%) initiating treatment the same day that treatment eligibility was determined. There were no abnormal laboratory blood results or adverse events that required medical intervention. Pre-delivery retention in care and infant mortality were comparable to those in similar settings. Of the 107 pregnancies with PCR outcomes available, there was 1 positive HIV result in an infant (0.9%). Maternal viral load suppression in this mother was not achieved by the time of delivery.
  
  
  CONCLUSIONS
  This pilot programme provides evidence that rapid ART initiation in pregnancy is safe, feasible and effective in reducing PMTCT. Further follow-up is required to monitor long-term outcomes.
authors.affiliation: Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa. samanthablack19@gmail.com
authors.forename: Samantha
authors.initials: S
authors.lastname: Black
authors.forename: Rose
authors.initials: R
authors.lastname: Zulliger
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.forename: Rebecca
authors.initials: R
authors.lastname: Marcus
authors.forename: Sharon
authors.initials: S
authors.lastname: Jeneker
authors.forename: Reghana
authors.initials: R
authors.lastname: Taliep
authors.forename: David
authors.initials: D
authors.lastname: Pienaar
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents