High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting
High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting
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DOI：
10.1111/j.1365-3156.2005.01526.x
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发表时间：
2005-12-01
影响因子：
3.3
通讯作者：
Humblet, P
中科院分区：
文献类型：
--
作者：
Manzi, M;Zachariah, R;Humblet, P
在一项预防母婴传播艾滋病毒方案中，确定：提供“选择退出”自愿咨询和艾滋病毒检测的可接受性;艾滋病毒阳性母亲在产前、分娩和产后6个月的随访中逐渐丧失的情况;设计队列研究方法回顾常规产前检查、VCT和PMTCT登记。结果在3136名新的产前母亲中，2996名[96%，95%置信区间（CI）：95-97]人接受了检测前咨询，2965人（95%，CI：94-96）接受了HIV检测，所有人都接受了检测后咨询。31名（1%）母亲拒绝接受艾滋病毒检测。共有646人（22%）艾滋病毒呈阳性，并被纳入防止母婴传播方案。288名（45%）母亲和222名（34%）婴儿接受了奈韦拉平。截至36周产前访视，累计失访（n = 646）为358例（55%，CI：51-59），截至分娩为440例（68%，CI：64-71），截至首次产后访视为450例（70%，CI：66-73），截至6个月产后访视为524例（81%，CI：78-84）。这使得只有122（19%，CI：16-22）的初始队列仍然在该计划中。绝大多数（87%）的分娩发生在周边地区的PMTCT是不可用的。结论在农村地区的医院设置，至少有9个每10个参加产前服务的母亲接受VCT，其中约四分之一是艾滋病毒阳性，并包括在PMTCT计划。如果要在我们的环境中扩大PMTCT的规模，到产后6个月随访时，超过四分之三的队列患者逐渐失访，需要“不同的行动方式”。
SETTING Thyolo District Hospital, rural Malawi.OBJECTIVES In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district.DESIGN Cohort study.METHODS Review of routine antenatal, VCT and PMTCT registers.RESULTS Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n = 646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available.CONCLUSIONS In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.