title: Implementation and Operational Research: Effect of Integration of HIV Care and Treatment Into Antenatal Care Clinics on Mother-to-Child HIV Transmission and Maternal Outcomes in Nyanza, Kenya: Results From the SHAIP Cluster Randomized Controlled Trial.
abstract: BACKGROUND
  Many HIV-infected pregnant women identified during antenatal care (ANC) do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants.
  
  
  METHODS
  We performed a cluster randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, prevention of mother-to-child transmission, and HIV care delivered in the ANC clinic; n = 6 intervention facilities) or standard ANC services (including prevention of mother-to-child transmission and referral to a separate clinic for HIV care; n = 6 control facilities).
  
  
  RESULTS
  There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was 12-month follow-up data for 256 of 611 (41.8%) women and postpartum data for only 325 of 1172 (28%) women. By 9 months of age, 382 of 568 (67.3%) infants at intervention sites and 338 of 594 (57.0%) at control sites had tested for HIV [odds ratio (OR) 1.45, 95% confidence interval (CI): 0.71 to 2.82]; 7.3% of infants tested HIV positive at intervention sites compared with 8.0% of infants at control sites (OR 0.89, 95% CI: 0.56 to 1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1%, OR 0.83, 95% CI: 0.41 to 1.68).
  
  
  CONCLUSIONS
  Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk of HIV transmission to infants and did not appear to affect short-term maternal health outcomes.
authors.affiliation: *Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, New York, NY; †Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya; ‡Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL; Departments of §Obstetrics, Gynecology, and Reproductive Sciences; ‖Medicine, University of California, San Francisco (UCSF), San Francisco, CA; and ¶US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Atlanta, GA.
authors.forename: Sierra
authors.initials: S
authors.lastname: Washington
authors.forename: Kevin
authors.initials: K
authors.lastname: Owuor
authors.forename: Janet M
authors.initials: JM
authors.lastname: Turan
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Steinfeld
authors.forename: Maricianah
authors.initials: M
authors.lastname: Onono
authors.forename: Starley B
authors.initials: SB
authors.lastname: Shade
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Marta L
authors.initials: ML
authors.lastname: Ackers
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D016000:Cluster Analysis; D003151:Community Health Centers / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya / Q000453:epidemiology; D008430:Maternal-Child Health Centers / Q000458:organization & administration; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents