Family-centred approaches to the prevention of mother to child transmission of HIV.
Family-centred approaches to the prevention of mother to child transmission of HIV.
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DOI：
10.1186/1758-2652-13-s2-s2
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发表时间：
2010-06-23
影响因子：
6
通讯作者：
Fawzi MC
中科院分区：
文献类型：
--
作者：
Betancourt TS;Abrams EJ;McBain R;Fawzi MC
预防母婴传播方案传统上范围狭窄，针对围产期的生物医学干预措施，而不是将艾滋病毒视为一种家庭疾病。这种有限的重点限制了方案的效力，扩大预防措施的机会在很大程度上被忽视。虽然预防垂直传播至关重要，但考虑到家庭环境可以加强防止母婴传播。以家庭为中心的艾滋病毒预防和护理办法是预防儿童感染同时改善家庭整体健康的一个重要方向。本文回顾了现有的关于采取更广泛或以家庭为中心的预防母婴传播方案模式的文献。我们描述了以家庭为中心的预防母婴传播的结果和障碍，并确定了一些有前途的新方向，可以实现更全面的儿童和家庭的服务。从1990年至今，通过PubMed、EMBASE和PsycINFO检索了关于以家庭为中心的预防母婴传播干预措施有效性的文献。产生了403份摘要。这些被缩小到那些描述或评估的PMTCT模型，针对更广泛的方面的家庭系统之前，期间和/或之后交付的婴儿在获得艾滋病毒感染的风险（N = 14）。预防母婴传播研究和方案模式中纳入的以家庭为中心的护理最常见的方面包括咨询、检测和向受感染的孕妇及其伴侣提供抗逆转录病毒治疗。抗逆转录病毒疗法也普遍扩大到其他受感染的家庭成员。让父亲参与以家庭为基础的预防母婴传播咨询、婴儿喂养咨询和一般决策的努力虽然有希望，但不太常见。预防母婴传播方案也很有希望，但很少见，这些方案利用干预措施来增强家庭能力和功能;其中包括对亲密伴侣暴力行为的风险评估、对心理健康问题的关注以及幼儿发展服务的整合。尽管存在障碍，但仍有许多机会扩大防止母婴传播服务，以满足整个家庭的健康需求。我们对利用这些方法的模式的审查表明，以家庭为中心的预防措施可以有效地纳入方案。然而，需要进行更多的研究，以便更彻底地评估它们对防止母婴传播以及对更广泛的家庭健康结果的影响。
Prevention of mother to child transmission (PMTCT) programmes have traditionally been narrow in scope, targeting biomedical interventions during the perinatal period, rather than considering HIV as a family disease. This limited focus restricts programmes' effectiveness, and the opportunity to broaden prevention measures has largely been overlooked. Although prevention of vertical transmission is crucial, consideration of the family environment can enhance PMTCT. Family-centred approaches to HIV prevention and care present an important direction for preventing paediatric infections while improving overall family health. This paper reviews available literature on PMTCT programmatic models that have taken a broader or family-centred approach. We describe findings and barriers to the delivery of family-centred PMTCT and identify a number of promising new directions that may achieve more holistic services for children and families. Literature on the effectiveness of family-centred PMTCT interventions available via PubMed, EMBASE and PsycINFO were searched from 1990 to the present. Four hundred and three abstracts were generated. These were narrowed to those describing or evaluating PMTCT models that target broader aspects of the family system before, during and/or after delivery of an infant at risk of acquiring HIV infection (N = 14). The most common aspects of family-centred care incorporated by PMTCT studies and programme models included counselling, testing, and provision of antiretroviral treatment for infected pregnant women and their partners. Antiretroviral therapy was also commonly extended to other infected family members. Efforts to involve fathers in family-based PMTCT counselling, infant feeding counselling, and general decision making were less common, though promising. Also promising, but rare, were PMTCT programmes that use interventions to enrich family capacity and functioning; these include risk assessments for intimate partner violence, attention to mental health issues, and the integration of early childhood development services. Despite barriers, numerous opportunities exist to expand PMTCT services to address the health needs of the entire family. Our review of models utilizing these approaches indicates that family-centred prevention measures can be effectively integrated within programmes. However, additional research is needed in order to more thoroughly evaluate their impact on PMTCT, as well as on broader family health outcomes.