Evaluation of a community health worker intervention and the World Health Organization's Option B versus Option A to improve antenatal care and PMTCT outcomes in Dar es Salaam, Tanzania: study protocol for a cluster-randomized controlled health systems implementation trial.
Evaluation of a community health worker intervention and the World Health Organization's Option B versus Option A to improve antenatal care and PMTCT outcomes in Dar es Salaam, Tanzania: study protocol for a cluster-randomized controlled health systems implementation trial.
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DOI：
10.1186/1745-6215-15-359
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发表时间：
2014-09-15
期刊：
影响因子：
2.5
通讯作者：
Bärnighausen TW
中科院分区：
文献类型：
--
作者：
Sando D;Geldsetzer P;Magesa L;Lema IA;Machumi L;Mwanyika-Sando M;Li N;Spiegelman D;Mungure E;Siril H;Mujinja P;Naburi H;Chalamilla G;Kilewo C;Ekström AM;Fawzi WW;Bärnighausen TW
艾滋病毒的母婴传播仍然是撒哈拉以南非洲的一个重要公共卫生问题。由于艾滋病毒检测和与预防母婴传播的联系发生在产前护理(ANC)中，包括坦桑尼亚在内的发展中国家的任何预防母婴传播方案面临的主要挑战是第一次访问ANC的延迟和总访问次数较少。社区卫生工作者(CHW)在各种环境中有效地增加了对临床服务的接受，改善了治疗的保留率和依从性。在2013年1月这项试验开始时，世界卫生组织建议选择A或B两种药物方案中的一种来预防艾滋病毒母婴传播(母婴传播)。目前仍在很大程度上不清楚哪种选择在公共医疗体系中实施时更有效。本研究旨在确定：(1)社区卫生工作者(CWH)干预和(2)预防母婴传播方案B在改善ANC和母婴传播结局方面的有效性、成本效益、可接受性和可行性。本研究是一项采用2×2析因设计的整群随机对照卫生系统实施试验。达累斯萨拉姆的Kinondoni和Ilala区的所有60个行政病房首先被随机分配到接受CHW干预或不接受CHW干预，然后接受选项B或A。根据护理标准，设施卫生工作者对错过预防母婴传播预约的患者进行跟踪，首先通过电话，然后进行家访。在接受卫生福利干预的病房中，卫生福利部：(1)通过家访确定孕妇，并将她们转介到产前护理；(2)向孕妇提供产前护理、母婴传播、分娩和产后护理的教育；(3)定期跟踪所有孕妇，以确定她们是否参加了非国大；以及(4)跟踪错过非国大或母婴传播预约的妇女。临床试验.gov：EJF22802。报名日期：2013年5月14日。本文的在线版本(DOI：10.1186/17456215-15-359)包含补充材料，授权用户可以使用。
Mother-to-child transmission of HIV remains an important public health problem in sub-Saharan Africa. As HIV testing and linkage to PMTCT occurs in antenatal care (ANC), major challenges for any PMTCT option in developing countries, including Tanzania, are delays in the first ANC visit and a low overall number of visits. Community health workers (CHWs) have been effective in various settings in increasing the uptake of clinical services and improving treatment retention and adherence. At the beginning of this trial in January 2013, the World Health Organization recommended either of two medication regimens, Option A or B, for prevention of mother-to-child transmission of HIV (PMTCT). It is still largely unclear which option is more effective when implemented in a public healthcare system. This study aims to determine the effectiveness, cost-effectiveness, acceptability, and feasibility of: (1) a community health worker (CWH) intervention and (2) PMTCT Option B in improving ANC and PMTCT outcomes. This study is a cluster-randomized controlled health systems implementation trial with a two-by-two factorial design. All 60 administrative wards in the Kinondoni and Ilala districts in Dar es Salaam were first randomly allocated to either receiving the CHW intervention or not, and then to receiving either Option B or A. Under the standard of care, facility-based health workers follow up on patients who have missed scheduled appointments for PMTCT, first through a telephone call and then with a home visit. In the wards receiving the CHW intervention, the CHWs: (1) identify pregnant women through home visits and refer them to antenatal care; (2) provide education to pregnant women on antenatal care, PMTCT, birth, and postnatal care; (3) routinely follow up on all pregnant women to ascertain whether they have attended ANC; and (4) follow up on women who have missed ANC or PMTCT appointments. ClinicalTrials.gov:EJF22802. Registration date: 14 May 2013. The online version of this article (doi:10.1186/1745-6215-15-359) contains supplementary material, which is available to authorized users.
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DOI：
10.1056/nejmoa0911486
发表时间：
2010-06-17
期刊：
The New England journal of medicine
影响因子：
--
作者：
Chasela CS;Hudgens MG;Jamieson DJ;Kayira D;Hosseinipour MC;Kourtis AP;Martinson F;Tegha G;Knight RJ;Ahmed YI;Kamwendo DD;Hoffman IF;Ellington SR;Kacheche Z;Soko A;Wiener JB;Fiscus SA;Kazembe P;Mofolo IA;Chigwenembe M;Sichali DS;van der Horst CM;BAN Study Group
通讯作者：
BAN Study Group
影响因子：
158.5
作者：
Jokhio, AH;Winter, HR;Cheng, KK
通讯作者：
Cheng, KK
影响因子：
7.7
作者：
Eldridge, Sandra M.;Ashby, Deborah;Kerry, Sally
通讯作者：
Kerry, Sally
DOI：
10.1097/qai.0b013e318047df88
发表时间：
2007-05-01
影响因子：
3.6
作者：
Creek, Tracy L.;Ntumy, Raphael;Kilmarx, Peter H.
通讯作者：
Kilmarx, Peter H.
DOI：
10.1097/qai.0b013e3181b323ff
发表时间：
2009-11-01
影响因子：
3.6
作者：
Kilewo, Charles;Karlsson, Katarina;Biberfeld, Gunnel
通讯作者：
Biberfeld, Gunnel