Acceptability and feasibility of testing for HIV infection at birth and linkage to care in rural and urban Zambia: a cross-sectional study
Acceptability and feasibility of testing for HIV infection at birth and linkage to care in rural and urban Zambia: a cross-sectional study
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DOI：
10.1186/s12879-020-4947-6
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发表时间：
2020-03-18
影响因子：
3.7
通讯作者：
Moss, William J.
中科院分区：
文献类型：
--
作者：
Sutcliffe, Catherine G.;Mutanga, Jane N.;Moss, William J.
背景婴儿早期诊断对于及时发现HIV感染婴儿并与护理相联系非常重要。已实施出生时检测，以促进艾滋病毒感染的早期诊断，但这可能带来新的挑战。进行这项研究是为了了解赞比亚南部城市和农村地区出生检测的可接受性和可行性。方法这项横断面研究于2016年至2018年在赞比亚南部省的利文斯通、乔马和马查的11家医院和诊所进行。在这些研究中心感染艾滋病毒的孕妇所生的婴儿有资格入组。入组后，对母亲进行问卷调查，并从婴儿中收集干血斑卡，在中心实验室进行检测。当有结果时，通知母亲返回诊所。根据同意参加的妇女比例和拒绝参加的妇女中不参加的原因，对生育测试的可接受性进行了评价。利用返回结果的周转时间、收到结果的妇女比例以及与婴儿检测阳性护理的联系，对出生时检测的可行性进行了评估。结果1403名妇女参与了这项研究。一小部分下降是由于拒绝出生检测（各研究中心的0 - 8.2%）。1290名妇女同意让她们的婴儿接受检测。接受结果的母亲比例范围为51.6%至92.1%，在利文斯通（51.6%对69.8%; p < 0.0001）和马查（69.5%对85.7%; p < 0.0001），医院明显低于诊所，但乔马（85.7%对92.1%; p = 0.34）则不然。对于收到检测结果的母亲来说，从样本收集开始的中位周转时间在利文斯通是67天，在马查和乔马是53天。总体而言，23名（1.8%）婴儿检测出艾滋病毒阳性，但只有8名（34.8%）婴儿在样本采集后的中位数68天（范围：29，784）内与护理有关。结论虽然出生时检测是可以接受的，但本研究强调了在集中实验室检测系统下的操作挑战。需要建立护理点平台，以便快速检测和返回结果，从而能够尽早识别感染艾滋病毒的儿童，将其与护理联系起来并进行治疗。
Background Early infant diagnosis is important for timely identification of HIV-infected infants and linkage to care. Testing at birth has been implemented to facilitate earlier diagnosis of HIV infection but may present new challenges. This study was conducted to understand the acceptability and feasibility of birth testing in urban and rural settings in southern Zambia. Methods This cross-sectional study was conducted at 11 hospitals and clinics in Livingstone, Choma, and Macha in Southern Province, Zambia from 2016 to 2018. Infants born to pregnant women living with HIV at the sites were eligible for enrollment. After enrollment, a questionnaire was administered to the mother and a dried blood spot card was collected from infants for testing at a central laboratory. When results were available, mothers were notified to return to the clinic. Acceptability of birth testing was evaluated based on the proportion of women who agreed to participate and the reasons for non-participation among women who declined. Feasibility of testing at birth was evaluated using turnaround times for returning results, the proportion of women receiving results, and linkage to care for infants testing positive. Results One thousand four hundred three women were approached for the study. A small proportion declined due to refusal of birth testing (0 to 8.2% across sites). One thousand two hundred ninety women agreed to have their infants tested. The proportion of mothers receiving results ranged from 51.6 to 92.1%, and was significantly lower at the hospital than clinics in Livingstone (51.6% vs. 69.8%; p < 0.0001) and Macha (69.5% vs. 85.7%; p < 0.0001) but not Choma (85.7% vs. 92.1%; p = 0.34). For mothers who received test results, the median turnaround time from sample collection was 67 days in Livingstone and 53 days in Macha and Choma. Overall, 23 (1.8%) infants tested positive for HIV but only 8 (34.8%) were linked to care a median of 68 days (range: 29, 784) after sample collection. Conclusions While testing at birth was acceptable, this study highlights the operational challenges under a centralized laboratory testing system. Point-of-care platforms are needed for rapid testing and return of results so HIV-infected children can be identified, linked to care, and treated as early as possible.