Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital
Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital
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DOI：
10.1097/01.qai.0000225032.52766.c2
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发表时间：
2006-06-01
影响因子：
3.6
通讯作者：
Mermin, Jonathan
中科院分区：
文献类型：
--
作者：
Homsy, Jaco;Kalamya, Julius N.;Mermin, Jonathan
目的：在非洲，预防母婴艾滋病毒传播（PMTCT）项目受到妇女及其男性伴侣接受程度有限的阻碍。在分娩期间进行常规艾滋病毒咨询和检测（HCT）已被提议作为增加预防母婴传播的一种方法，但在非洲的规划背景下，这种干预措施的影响的数据很少。设计和方法：2004年5月，在乌干达农村一家拥有200张床位的医院的产前诊所设立了预防母婴传播服务；2004年12月，非国大预防母婴传播服务成为可选择退出的服务，并在产房建立了常规可选择退出的产房内母婴传播服务。我们比较了2004年12月至2005年9月期间产妇和非国大预防母婴传播服务的可接受性、可行性和吸纳性。结果：孕妇HCT接受率女性为97%(3591/3696)，伴孕男性为97%(104/107)，孕妇伴孕男性为86%(522/ 605)，伴孕男性为98%（176/180）。34名妇女通过分娩检测发现艾滋病毒血清阳性，艾滋病毒感染检出率增加了12%（34/278）。其中14人在分娩前收到了检查结果和奈韦拉平。在此期间，有艾滋病毒感染记录的产妇出院比例从39%（480/1235）增加到88%（1395/1594）。只有2.8%的无证妇女在ANC对其男性伴侣进行了检测，而在产科病房进行检测的比例为25%。在所有到任何一个单位就诊的男性伴侣中，只有48%（51/107）的人在非产院与妻子一起接受咨询，而在产科病房，这一比例为72%（130/ 180）。在ANC接受检测的所有人中，有2.8%的夫妇接受了咨询，而在产科病房接受检测的所有人中，这一比例为37%。结论：产时HCT可能是提高个人和夫妻参与预防母婴传播干预的一种可接受和可行的方法。
Objective: In Africa, prevention of mother-to-child HIV transmission (PMTCT) programs are hindered by limited uptake by women and their male partners. Routine HIV counseling and testing (HCT) during labor has been proposed as a way to increase PMTCT uptake, but little data exist on the impact of such intervention in a programmatic context in Africa.Design and Methods: In May 2004, PMTCT services were established in the antenatal clinic (ANC) of a 200-bed hospital in rural Uganda; in December 2004, ANC PMTCT services became opt-out, and routine opt-out intrapartum HCT was established in the maternity ward. We compared acceptability, feasibility, and uptake of maternity and ANC PMTCT services between December 2004 and September 2005.Results: HCT acceptance was 97% (3591/3696) among women and 97% (104/107) among accompanying men in the ANC and 86% (522/ 605) among women and 98% (176/180) among their male partners in the maternity. Thirty-four women were found to be HIV seropositive through intrapartum testing, representing an 12% (34/278) increase in HIV infection detection. Of these, 14 received their result and nevirapine before delivery. The percentage of women discharged from the maternity ward with documented HIV status increased from 39% (480/1235) to 88% (1395/1594) over the period. Only 2.8% of undocumented women had their male partners tested in the ANC in contrast to 25% in the maternity ward. Of all male partners who presented to either unit, only 48% (51/107) came together and were counseled with their wife in the ANC, as compared with 72% (130/ 180) in the maternity ward. Couples counseled together represented 2.8% of all persons tested in the ANC, as compared with 37% of all persons tested in the maternity ward.Conclusion: Intrapartum HCT may be an acceptable and feasible way to increase individual and couple participation in PMTCT interventions.