Implementing prevention policies for mother-to-child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013-2016
Implementing prevention policies for mother-to-child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013-2016
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DOI：
10.2471/blt.18.217471
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发表时间：
2019-03-01
影响因子：
11.1
通讯作者：
Renju, Jenny
中科院分区：
文献类型：
--
作者：
Jones, Harriet;Wringe, Alison;Renju, Jenny
目的评估世界卫生组织(WHO)指南在马拉维、南非和坦桑尼亚农村地区预防艾滋病毒母婴传播(PMTCT)国家政策中的采纳情况，并监测设施层面指南的实施情况。方法我们总结了2013-2016年国家母婴传播政策和WHO指南在母婴保健级联中的15项指标。在为5个健康和人口监测系统人口提供服务的46个卫生设施中进行了两轮调查(2013-2015年和2015-2016年)。我们向设施经理发放了结构化问卷，以描述服务交付情况。我们报告实施每项指标的设施比例以及用品缺货的频率和持续时间，按地点和调查周期分列。在所有国家发现，到2016年，影响母婴预防母婴传播级联护理的国家政策与世卫组织指导方针保持一致；大多数国家间政策差异涉及与常规艾滋病毒护理的联系。在同一大楼内提供检测后咨询、当天抗逆转录病毒疗法(ART)启动、产前护理和ART提供的设施以及备选方案B+的比例在所有地点都增加或保持在100%。在执行婴儿诊断和治疗政策方面的进展因地点而异。在过去的一年中，HIV检测试剂盒或抗逆转录病毒药物的缺货总体上有所下降，但在两轮调查中，每个地点至少有一个机构报告了缺货情况。结论在这些情况下，预防母婴传播政策的实施取得了进展。然而，整个婴儿护理和供应链挑战的持续差距，有可能破坏消除婴儿艾滋病毒的目标。
Objective To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania.Methods We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 2013-2016. Two survey rounds were conducted (2013-2015 and 2015-2016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round.Findings In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock-outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds.Conclusion Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals.