Closing the gaps in PMTCT program coverage, early infant diagnosis and treatment.

缩小预防母婴传播计划覆盖范围、婴儿早期诊断和治疗方面的差距。

• 批准号: 8554916
• 负责人: Mary-Ann Davies
• 金额: $ 38.83万
• 依托单位: UNIVERSITY OF CAPE TOWN
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-28 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8554916
• 关键词: African; Anti-Retroviral Agents; Blood Tests; CD4 Lymphocyte Count; Caring; Child; Clinic; Clinical; Complement; Continuity of Patient Care; Country; Data; Diagnosis; Discipline of obstetrics; Drops; Effectiveness; Electronics; Ensure; Failure; Fostering; Future; Goals; Guidelines; HIV; HIV Seropositivity; Health Services; Health system; Individual; Infant; Infant Care; Intervention; Investigation; Laboratories; Link; Modeling; Monitor; Morbidity - disease rate; Mothers; Paper; Performance; Pharmaceutical Preparations; Pregnant Women; Prevalence; Prevention; Preventive; Primary Health Care; Protocols documentation; Provider; Province; Reporting; Services; South Africa; System; Technology; Test Result; Testing; Umbilical Cord Blood; Vertical Disease Transmission; Work; antiretroviral therapy; base; design; improved; infancy; mortality; pediatric human immunodeficiency virus; postnatal; prevent; programs; public health emergency; quality assurance; therapy design; transmission process; virtual

DESCRIPTION (provided by applicant): Virtual elimination of vertical transmission of HIV is within reach in South Africa. Despite high antenatal HIV prevalence, implementation of currently available technology and guidelines in the South African Prevention of Mother-to-Child Transmission (PMTCT) program, and particularly the longstanding and comprehensive program in the Western Cape Province, South Africa, has resulted in substantial reductions in vertically transmitted HIV to 3.5% across the country, and 3.3% in the Western Cape. Yet, elimination remains elusive due to persistent coverage gaps and drop-offs at each of the steps required in completion of the PMTCT and infant care continuum, with upwards of 1000 vertically infected infants born in the Western Cape each year. Improving the performance of the current PMTCT and antiretroviral therapy (ART) guidelines at each point in the care continuum through meticulous surveillance of system failures with resultant intervention, are key to further mitigating the effect of HIV on children, irrespective of possible future introduction of different guideline and service design options. Strengthening the health system with this active surveillance approach will provide long term benefits that will both complement and endure beyond future changes in drug protocols or service delivery models. This system will foster a paradigm in which identified cases of infant HIV exposure not covered by PMTCT drugs and HIV infected infants are viewed as a public health emergency requiring urgent intervention to identify reasons for program failure and mitigate its effects in an individual child. This project focused on a primary care obstetric facility, aims to implement and evaluate three linked enhancements to the existing service platform that will iteratively identify and close all PMTCT and early infant diagnosis and ART coverage gaps. First, existing paper registers at antenatal, obstetric and infant clinics will be digitized, internally linked, and merged with laboratory data using context-appropriate technology that has been applied to other priority programs, namely ART and TB monitoring. The combined PMTCT e-register will be linked to a system of urgent reporting of laboratory results of low CD4 counts in pregnant women and positive infant HIV-PCR test results to clinics, with tracing to ensure prompt ART initiation. This will strengthen the health system to close these key PMTCT coverage gaps. Second, a system of routine cord blood testing for HIV, and, if positive, the presence of antiretroviral drugs (ARVs) will identify and link to care HIV-exposed infants with no/suboptimal peripartum ARVs to ensure interventions to prevent postnatal transmission, prompt infant diagnosis and ART if infected. Third, a program of clinical quality assurance, improvement and audit will be established. This will be based on data from both the e-register and cord blood surveillance that will generate an early warning system of coverage gaps. Using these data, PMTCT program failures will be regularly and systematically analyzed together with Provincial and Local Departments of Health service managers and providers, with a view to achieving iterative service improvements.

描述（由申请人提供）：在南非，艾滋病毒垂直传播的实际消除是触手可及的。尽管产前艾滋病毒感染率很高，但在南非预防母婴传播（PMTCT）项目中，特别是在南非西开普省实施的长期综合项目中，现有技术和指导方针的实施，已使全国垂直传播的艾滋病毒感染率大幅下降至3.5%，西开普省下降至3.3%。然而，由于持续存在的覆盖差距和完成预防母婴传播和婴儿护理连续体所需的每个步骤的下降，消除仍然难以实现，每年在西开普省出生的纵向感染婴儿超过1000名。无论未来是否可能引入不同的指导方针和服务设计方案，通过对系统失败的细致监测和相应的干预措施，在护理连续体的每个阶段改进当前预防母婴传播和抗逆转录病毒治疗（ART）指南的绩效是进一步减轻艾滋病毒对儿童影响的关键。通过这种主动监测方法加强卫生系统将带来长期效益，这将补充并持续超越未来药物方案或服务提供模式的变化。这一系统将形成一种范例，在这种范例中，预防母婴传播药物未涵盖的婴儿感染艾滋病毒病例和感染艾滋病毒的婴儿被视为需要紧急干预的公共卫生紧急情况，以确定方案失败的原因，并减轻其对个别儿童的影响。该项目侧重于初级保健产科设施，旨在实施和评估对现有服务平台的三个相关改进，这些改进将迭代地确定和缩小所有预防母婴传播和早期婴儿诊断以及抗逆转录病毒治疗覆盖率的差距。首先，将对产前、产科和婴儿诊所现有的纸质登记册进行数字化、内部链接，并使用已应用于其他重点规划（即抗逆转录病毒治疗和结核病监测）的适合具体情况的技术与实验室数据合并。预防母婴传播联合电子登记将与向诊所紧急报告孕妇CD4细胞计数低的实验室结果和婴儿艾滋病毒聚合酶链反应检测结果阳性的系统联系起来，并进行追踪，以确保及时启动抗逆转录病毒治疗。这将加强