Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma.
Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma.
复制标题
DOI：
10.1186/1758-2652-14-61
复制
发表时间：
2011-12-28
影响因子：
6
通讯作者：
John-Stewart G
中科院分区：
文献类型：
--
作者：
Kinuthia J;Kiarie JN;Farquhar C;Richardson BA;Nduati R;Mbori-Ngacha D;John-Stewart G
我们着手确定污名与卫生系统在不采取预防母婴传播（PMTCT）的HIV-1干预措施中的相对作用：我们对所有同意陪同婴儿进行六周免疫接种的母亲进行了横断面评估。2008年9月至2009年3月期间，在肯尼亚内罗毕和尼扬扎省的六个妇幼保健诊所，对母亲进行了关于最近怀孕期间预防母婴传播干预措施的采访。污名是确定使用以前出版的标准化问卷和婴儿HIV-1的状态确定的HIV-1聚合酶链反应。在2663名母亲中，2453名（92.1%）报告产前HIV-1检测。未经检测的母亲更有可能受过中等以下教育（85.2%对74.9%，p = 0.001），来自尼扬扎（47.1%对32.2%，p < 0.001），社会经济地位较低。在318名HIV-1感染的母亲中，90%报告使用了母婴抗逆转录病毒药物。在HIV-1感染的母亲中，设施分娩不太常见（69%对76%，p = 0.009），并且与抗逆转录病毒药物的使用有关（p < 0.001）。尽管12%至59%的妇女报告了内部或外部耻辱指标，但耻辱与较低的HIV-1检测或婴儿HIV-1感染率无关;内部耻辱与抗逆转录病毒药物摄入量的适度减少有关。卫生系统因素导致约60%的到产前诊所就诊的母亲未进行检测，并导致错过提供抗逆转录病毒药物和利用设施分娩的机会。六周大的HIV-1暴露婴儿中有8%感染了HIV-1。产前艾滋病毒-1检测和抗逆转录病毒药物使用率很高（均超过90%），婴儿感染艾滋病毒-1的风险很低，这反映了防止母婴传播的覆盖率很高。投资于卫生系统，提供艾滋病毒-1检测和抗逆转录病毒药物，可以有效预防婴儿感染艾滋病毒-1，尽管艾滋病毒-1的耻辱感很大。
We set out to determine the relative roles of stigma versus health systems in non-uptake of prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional assessment of all consenting mothers accompanying infants for six-week immunizations. Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya's Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy. Stigma was ascertained using a previously published standardized questionnaire and infant HIV-1 status determined by HIV-1 polymerase chain reaction. Among 2663 mothers, 2453 (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001) and have lower socio-economic status. Among 318 HIV-1-infected mothers, 90% reported use of maternal or infant antiretrovirals. Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, p = 0.009) and was associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six-week-old HIV-1-exposed infants were HIV-1 infected. Antenatal HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV-1 infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV-1 testing and antiretrovirals can effectively prevent infant HIV-1 infection despite substantial HIV-1 stigma.
登录
查看更多内容
影响因子：
168.9
作者：
Coutsoudis, A;Pillay, K;Coovadia, HM
通讯作者：
Coovadia, HM
DOI：
10.1097/00126334-200112010-00010
发表时间：
2001-12-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
--
作者：
Nebié, Y;Meda, N;Dabis, F
通讯作者：
Dabis, F
DOI：
10.1097/qai.0b013e31819001a3
发表时间：
2009-02-01
影响因子：
3.6
作者：
Delvaux, Therese;Elul, Batya;Asiimwe, Anita
通讯作者：
Asiimwe, Anita
DOI：
10.1097/00126334-200204150-00009
发表时间：
2002-04-15
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
--
作者：
Cooper, ER;Charurat, M;Blattner, W
通讯作者：
Blattner, W
影响因子：
4.5
作者：
Karamagi, Charles A. S.;Tumwine, James K.;Heggenhougen, Kristian
通讯作者：
Heggenhougen, Kristian