Health Facility Characteristics and Their Relationship to Coverage of PMTCT of HIV Services across Four African Countries: The PEARL Study
Health Facility Characteristics and Their Relationship to Coverage of PMTCT of HIV Services across Four African Countries: The PEARL Study
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DOI：
10.1371/journal.pone.0029823
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发表时间：
2012-01-20
期刊：
影响因子：
3.7
通讯作者：
Dabis, Francois
中科院分区：
文献类型：
--
作者：
Ekouevi, Didier K.;Stringer, Elizabeth;Dabis, Francois
背景资料：卫生设施的特点与有效预防母婴传播的艾滋病毒（PMTCT）覆盖率在撒哈拉以南地区知之甚少。方法/主要调查结果：我们进行了调查，积极的PMTCT服务在喀麦隆，科特迪瓦，南非和赞比亚的卫生设施。数据是通过直接观察和离职面谈汇编的。我们构建了综合得分来描述提供的PMTCT服务在七个主题领域：产前质量，PMTCT质量，供应可用，病人满意度，病人对药物的理解，和基础设施质量。皮尔逊相关性和广义估计方程（GEE），以考虑集群的设施在国家内被用来评估之间的关系的综合评分，总访问时间和选择个别变量与PMTCT的妇女提供的覆盖面。在2008年7月至2009年5月期间，我们收集了32个设施的数据; 78%由政府卫生系统管理。赞比亚100%的设施采用了选择退出的艾滋病毒检测方法，喀麦隆63%，科特迪瓦和南非没有。使用Pearson相关性，PMTCT覆盖率（中位数为55%，（IQR：33-68）与PMTCT质量评分相关（rho = 0.51; p = 0.003）;基础设施质量评分（rho = 0.43; p = 0.017）;在诊所花费的时间（rho = 0.47; p = 0.013）;患者对药物的理解评分（rho = 0.51; p = 0.006）;和患者满意度质量评分（rho = 0.38; p = 0.031）。预防母婴传播覆盖率与产前质量评分略有相关（rho = 0.304; p = 0.091）。使用GEE校正聚类，产前质量评分与PMTCT覆盖率的相关性更强（p
Background: Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood.Methodology/Principal Findings: We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78% were managed by the government health system. An opt-out approach for HIV testing was used in 100% of facilities in Zambia, 63% in Cameroon, and none in Cote d'Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33-68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47; p = 0.013); patient understanding of medications score (rho = 0.51; p = 0.006); and patient satisfaction quality score (rho = 0.38; p = 0.031). PMTCT coverage was marginally correlated with the antenatal quality score (rho = 0.304; p = 0.091). Using GEE adjustment for clustering, the, antenatal quality score became more strongly associated with PMTCT coverage (p