Using a campaign approach among health workers to increase access to antiretroviral therapy for pregnant HIV-infected women in South Africa.

Overview

BACKGROUND: In 2010, WHO guidelines modified eligibility criteria for persons living with HIV to start on lifelong antiretroviral therapy. Pregnant HIV-infected women were identified as a priority group. Yet, despite the availability of key resources and medications, antiretroviral treatment rates for pregnant women in South Africa remained low. METHODS: A prospective, nonrandomized, controlled study to evaluate the impact of a campaign approach among health workers to improve referral and initiation rates of antiretroviral therapy for eligible pregnant HIV-infected women in 2 matched districts in KwaZulu-Natal Province. RESULTS: The average number of referrals of pregnant women for antiretroviral therapy increased from 79 per month (95% confidence interval [CI]: 69 to 89) at baseline to 188 per month (95% CI: 167 to 209) 6 months after the intervention (P < 0.001). Similarly, the number of pregnant women initiated on antiretroviral therapy increased from 21 per month (95% CI: 2 to 40) at baseline to 124 per month (95% CI: 108 to 140) after the intervention (P < 0.001). Unlike in the control district, where no improvements were seen, the intervention district showed a greater than 4-fold increase in women initiated on antiretroviral therapy. CONCLUSION: A targeted campaign among health workers can accelerate access to antiretroviral therapy for pregnant HIV-infected women.