Integration of Prevention of Mother-to-Child Transmission of HIV (PMTCT) Postpartum Services with Other HIV Care and Treatment Services within the Maternal and Child Health Setting in Zimbabwe, 2012
Integration of Prevention of Mother-to-Child Transmission of HIV (PMTCT) Postpartum Services with Other HIV Care and Treatment Services within the Maternal and Child Health Setting in Zimbabwe, 2012
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DOI：
10.1371/journal.pone.0098236
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发表时间：
2014-06-10
期刊：
影响因子：
3.7
通讯作者：
Kilmarx, Peter H.
中科院分区：
文献类型：
--
作者：
Wiegert, Katherine;Dinh, Thu-Ha;Kilmarx, Peter H.
背景：我们评估了津巴布韦妇幼保健机构产后母婴传播服务的整合情况，包括婴儿早期艾滋病毒诊断(EID)和成人和儿童抗逆转录病毒治疗(ART)。方法和结果：2012年8月至12月，我们对具有全国代表性的151家妇幼保健机构进行了横断面调查。使用问卷调查了每个地点的工作人员培训、干血点样本(DBS)采集、检测结果的周转时间(TAT)、预防母婴传播服务以及艾滋病毒感染母亲、儿童和暴露于艾滋病毒的婴儿的艾滋病毒护理和治疗联系。研究采用描述性分析。在接受调查的设施中，所有设施都接受了DBS收集方面的培训，92%的机构做出了答复。大约99%的答复机构报告提供了DBS收集和基本的艾滋病毒暴露婴儿服务包，包括EID、奈韦拉平延长预防和使用复方新诺明。83%的设施将DBS收集与免疫结合起来，37%的设施提供了使用护理点式机器的CD4检测，27%的设施提供了母亲和儿童的抗逆转录病毒治疗。超过80%的机构报告说，DBS检测结果需要&>4周才能返回；TAT与任何特定的运输类型、到实验室的距离或数据传播的中间站没有直接联系。结论：津巴布韦成功地扩大了国家EID和母婴传播计划，并将其整合到现有的妇幼保健设置中。婴儿DBS检测结果的冗长TAT以及妇幼保健环境中缺乏综合ART计划可能会降低国家预防母婴传播和ART计划的有效性。消除这些重大差距将有助于成功执行2014年津巴布韦预防母婴传播指导方针，根据该准则，所有感染艾滋病毒的孕妇和哺乳期妇女将获得终身艺术和分散的艺术关怀。
Background: We assessed the integration of PMTCT services during the postpartum period including early infant diagnosis of HIV (EID) and adult and pediatric antiretroviral therapy (ART) in maternal and child health (MCH) facilities in ZimbabweMethods and Findings: From August to December 2012 we conducted a cross-sectional survey of a nationally representative sample of 151 MCH facilities. A questionnaire was used to survey each site about staff training, dried blood spot sample (DBS) collection, turnaround time (TAT) for test results, PMTCT services, and HIV care and treatment linkages for HIV-infected mothers and children and HIV-exposed infants. Descriptive analyses were used. Of the facilities surveyed, all facilities were trained on DBS collection and 92% responded. Approximately, 99% of responding facilities reported providing DBS collection and a basic HIV-exposed infant service package including EID, extended nevirapine prophylaxis, and use of cotrimoxazole. DBS collection was integrated with immunisations at 83% of facilities, CD4 testing with point-of-care machines was available at 37% of facilities, and ART for both mothers and children was provided at 27% of facilities. More than 80% of facilities reported that DBS test results take >4 weeks to return; TAT did not have a direct association with any specific type of transport, distance to the lab, or intermediate stops for data to travel.Conclusions: Zimbabwe has successfully scaled up and integrated the national EID and PMTCT programs into the existing MCH setting. The long TAT of infant DBS test results and the lack of integrated ART programs in the MCH setting could reduce effectiveness of the national PMTCT and ART programs. Addressing these important gaps will support successful implementation of the 2014 Zimbabwe's PMTCT guidelines under which all HIV-infected pregnant and breastfeeding women will be offered life-long ART and decentralized ART care.