Outcomes and challenges of scaling up comprehensive PMTCT services in rural Swaziland, Southern Africa
Outcomes and challenges of scaling up comprehensive PMTCT services in rural Swaziland, Southern Africa
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DOI：
10.1080/09540121003615079
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发表时间：
2010-01-01
影响因子：
1.7
通讯作者：
Mareverwa, Joyce
中科院分区：
文献类型：
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作者：
Bancheno, Wouhabe Marai;Mwanyumba, Fabian;Mareverwa, Joyce
为了减轻艾滋病毒感染对孕妇及其子女的负面影响，需要提供全面服务，防止母婴传播。我们报告的成果和挑战的综合服务，以防止母婴传播艾滋病毒感染的转诊医院和诊所在斯威士兰农村，南部非洲实施2007年1月至12月。我们审查了每月报告，医院登记册和现场日记，并采访了64个服务提供者。在首次和重复产前保健检查中共进行了460次艾滋病毒检测。从完成的测试中，收集了93.7%的结果。69.1%的首次入境者接受了HIV检测。孕妇使用奈韦拉平（NVP）+/-齐多夫定（AZT）的产前覆盖率为100%。在443名接受CD 4检测的产前和产后护理妇女中，54.4%收集了结果。收集结果的人中约有16.3%开始接受抗逆转录病毒治疗。产后出院时艾滋病毒状况不明的妇女比例下降了64.8%。约91.5%的HIV阳性妇女在产后1周内接受了NVP和AZT +拉米夫定的抗逆转录病毒预防。在接触NVP的新生儿中，98.8%接受NVP初始剂量和AZT。共有304名年龄在6周到18个月之间的艾滋病毒暴露婴儿接受了DNA-PCR检测。母婴同时接受抗逆转录病毒预防的婴儿感染率为16.1%（n=243）。首次产前检查接受艾滋病毒检测的比例、收集CD 4和DNA-PCR检测结果的客户比例都很低，需要改进机制。在这项研究中，DNA-PCR阳性婴儿接触的比例高于南部非洲的其他报告。婴儿喂养方式、检测年龄和分娩方式可以解释这些结果的差异。在资源有限的情况下提供全面的预防母婴传播服务是可能的，但面临工作人员短缺、社会经济和服务相关因素的挑战。
To mitigate the negative impacts of HIV infection on pregnant women and their children, comprehensive services to prevent mother to child transmission are required. We report the outcomes and challenges of a comprehensive service to prevent mother to child transmission of HIV infection implemented from January to December 2007 in a referral hospital and its rollout clinics in rural Swaziland, Southern Africa. We reviewed monthly reports, hospital registers, and field diaries and interviewed 64 service providers. A total of 460 HIV tests were done on first and repeat antenatal care visits. From the test done, 93.7% of the results were collected. About 69.1% of first-time visitors accepted HIV test. The antenatal coverage of pregnant women with nevirapine (NVP)+/- zidovudine (AZT) was 100%. Of 443 antenatal and post-natal care women who underwent CD4 test, 54.4% collected results. About 16.3% of those who collected results were started on antiretroviral treatment. The percentage of postpartum women discharged with unknown HIV status fell by 64.8%. About 91.5% of HIV-positive women received intrapartum antiretroviral prophylaxis of stat dose NVP and AZT + lamivudine with 1-week postpartum tail. From the exposed newborns, 98.8% received NVP stat dose and AZT. A total of 304 HIV exposed infants of age six weeks to 18 months underwent DNA-PCR test. The prevalence of infection among infants where both mother and infant received antiretroviral prophylaxis was 16.1% (n=243). HIV test acceptance rate at first antenatal care visit, proportion of clients collecting CD4 and DNA-PCR test results were low and call for mechanisms for improvement. The proportion of DNA-PCR-positive exposed infants in this study was higher than other reports from Southern Africa. The variation of the findings could be explained by mode of infant feeding, age of testing and mode of delivery. Provision of comprehensive prevention of mother to child transmission services in resource limited setting is possible but challenged by staff shortage, socio-economic and service-related factors.