A Cost-Outcomes Analysis of Provision of Antiretroviral Therapy at Maternal And Child Health Centers and Referral to a General ART Clinic

Project Description

HIV-infected pregnant women should initiate antiretroviral therapy (ART) as soon as possible for their own health and for the Prevention of Mother to Child Transmission (PMTCT). In Kenya, current guidelines recommend initiation of ART during pregnancy with CD4 < 350 cells/mm3 or WHO Stage III or IV.  Antiretroviral prophylaxis strategies are available for women who are not ART eligible during pregnancy for PMTCT. After delivery, these women need to remain on ART for life.  The Kenyan Ministry of Health (MoH) in collaboration with the Kenya Medical Research Institute/Walter Reed Project (KEMRI/WRP) established a policy in 2005 to initiate ART for eligible pregnant women at the Kericho District Hospital (KDH) under the auspices of the President’s Emergency Plan for AIDS Relief (PEPFAR) program.  After delivery, these women continue to attend the KDH Maternal Child Health Clinic (MCH) for a standard package of clinical services including ART through 18 months post-partum.  After 18 months, these women are then referred to the KDH HIV clinic to continue their long-term ART and care.

CGHD is collaborating with KEMRI/WRP to evaluate the provision of ART to women at the MCH. The primary purpose of this study is to evaluate the health facility costs of providing ART to ART-eligible pregnant women presenting to the KDH MCH through 24 months post-partum and to evaluate if these women successfully complete the transition from the KDH MCH clinic (after 18 months of follow-up) to the hospital’s general HIV clinic for long term ART and care (additional 6 months of follow-up). To provide additional comparison information, similar costs of ART provision and outcomes achieved will be evaluated for two additional sites/study populations: women initiating ART at the KDH general HIV clinic and pregnant women initiating ART at the James Finlay Kenya (JFK) Central Hospital.

Project Details

Principal Investigator Bruce Larson
Boston University Co-Investigators Julia Rohr
Collaborators Maggie Bii, Kenya Medical Research Institute (KEMRI), Walter Reed Project
Country Kenya
Dates of Research 2011-2014
Donor/Funder Henry Jackson Foundation