Integration of HIV and maternal healthcare in a high HIV-prevalence setting: analysis of client flow data over time in Swaziland
Integration of HIV and maternal healthcare in a high HIV-prevalence setting: analysis of client flow data over time in Swaziland
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DOI：
10.1136/bmjopen-2013-003715
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发表时间：
2014-01-01
期刊：
影响因子：
2.9
通讯作者：
Fenty, Justin
中科院分区：
文献类型：
--
作者：
Birdthistle, Isolde J.;Mayhew, Susannah H.;Fenty, Justin
妇幼保健可为艾滋病毒高流行率环境中的艾滋病毒服务提供一个切入点。我们的目标是评估艾滋病毒与妇幼保健服务在斯威士兰公共部门设施的整合。设计在2009年，2010年和2012年，客户流量评估（CFA）进行了为期5天的8个政府设施的妇幼保健单位，有目的地选择作为干预或比较网站。2009 - 2010年为加强将艾滋病毒服务纳入产后护理而开展的活动和投入的资源。在所有访问中，客户接受艾滋病毒咨询的比例。ResultsAcross设施，艾滋病毒/性传播感染和妇幼保健服务的访问中收到的比例有很大的不同，例如，在2009年从9%到49%。艾滋病毒/性传播感染服务最常与儿童保健、产前保健和计划生育（妇女就诊的最常见原因）相结合，最不常与PNC和宫颈筛查相结合。随着时间的推移，设计组的整合没有有意义的差异，设施之间存在相当大的异质性。一个干预机构和两个比较机构接受的综合服务有所增加，其中艾滋病毒咨询也有所增加，而一个干预机构和两个比较机构的艾滋病毒咨询则有所下降。结论所有机构都提供艾滋病毒/性传播感染服务和妇幼保健护理，但接受综合服务的妇女相对较少。艾滋病毒咨询服务的增加推动了融入工作的增加，而一些设施的数量急剧下降，表明融入工作难以持续。加强艾滋病毒整合的机会在于ANC，CH和FP，而HIV-PNC整合将仍然有限，直到更多的妇女参加PNC。
ObjectiveMaternal and child health (MCH) care may provide an entry point for HIV services in high HIV-prevalence settings. Our objective was to assess integration of HIV with MCH services in public sector facilities in Swaziland.DesignIn 2009, 2010 and 2012, client flow assessments (CFAs) were conducted over 5 days in the MCH units of eight government facilities, purposively selected as intervention or comparison sites.Participants8263 MCH visits with female clients were tracked: 3261 in 2009, 2086 in 2010 and 2916 in 2012.InterventionActivities and resources to strengthen integration of HIV services into postnatal care (PNC), 2009-2010.Main outcome measuresThe proportion of all visits in which an HIV/sexually transmitted infection (STI) testing, counselling or treatment was received together with an MCH service; the proportion of all visits in which a client receives HIV counselling.ResultsAcross facilities, the proportion of visits in which HIV/STI and MCH services were received varied considerably, for example, from 9% to 49% in 2009. HIV/STI services were integrated most frequently with child health (CH), antenatal care (ANC) and family planning (FP)-the most common reasons for women's attendance-and least often with PNC and cervical screening (CS). There was no meaningful difference in integration over time by design group and considerable heterogeneity across facilities. Receipt of integrated services increased in one intervention and two comparison facilities, where HIV counselling also rose, and fell in one intervention and two comparison facilities.ConclusionsProvision of HIV/STI services with MCH care occurred at all facilities, yet relatively few women receive integrated services. Increases in integration were driven by increases in HIV counselling, while sharp declines in some facilities indicate that integration is difficult to sustain. Opportunities for intensifying HIV integration lie with ANC, CH and FP, while HIV-PNC integration will remain limited until more women attend PNC.Trial registration numberCurrent Controlled Trials NCT01694862.