Perez Freddy, Mukotekwa Tarisai, Miller Anna, Orne-Gliemann Joanna, Glenshaw Monica, Chitsike Inam, Dabis François
Institut de Santé Publique, d'Epidemiologie et de Développement (ISPED), Université Victor Segalen, Bordeaux, France.
Trop Med Int Health. 2004 Jul;9(7):774-83. doi: 10.1111/j.1365-3156.2004.01264.x.
To report on activities and lessons learned during the first 18 months of a rural programme of prevention of mother-to-child transmission of HIV (PMTCT) in Zimbabwe.
The PMTCT services were introduced in Murambinda Mission Hospital (120 beds), Buhera, in 2001. Programme strategies consisted in recruiting counselling staff, training health professionals, improving mother-child health (MCH) facilities and conducting information, education and communication activities within the community to address HIV/AIDS awareness and stigma. The following components were implemented within MCH services: voluntary counselling and testing of HIV using rapid testing, nevirapine short regimen proposed to all HIV-infected mothers identified and their newborns, support to exclusive breastfeeding for 6- and 18-month mother-child follow-up. Routine monitoring data collected from August 2001 to February 2003 were used to estimate programme uptake.
Of 2471 pregnant women using antenatal services, 2298 were pre-test counselled, the acceptance of HIV testing reached 92.9%. Of the women who decided to take an HIV test, 1588 (74.3%) returned to collect their result. Overall HIV prevalence was 20.4% (n = 437); 326 of the HIV-positive women were counselled and 104 (24%) received complete mother-child antiretroviral prophylaxis.
Acceptability of HIV testing after counselling has remained above 90% since the onset of the programme. Collection of test results and mother-child follow-up are among the most challenging activities of the programme. A district approach and community participation are critical to develop PMTCT programmes in rural settings, even with reasonably good MCH services.
报告津巴布韦一项农村地区预防母婴传播艾滋病毒（PMTCT）项目头18个月的活动及经验教训。
2001年在布赫拉的穆兰宾达传教士医院（120张床位）引入了PMTCT服务。项目策略包括招聘咨询人员、培训卫生专业人员、改善母婴健康（MCH）设施，以及在社区内开展信息、教育和宣传活动，以提高对艾滋病毒/艾滋病的认识并消除耻辱感。在MCH服务中实施了以下组成部分：使用快速检测法进行艾滋病毒自愿咨询和检测，向所有确诊的艾滋病毒感染母亲及其新生儿提供奈韦拉平短程疗法，支持纯母乳喂养并对母婴进行6个月和18个月的随访。利用2001年8月至2003年2月收集的常规监测数据来评估项目的实施情况。
在2471名使用产前服务的孕妇中，2298人接受了检测前咨询，艾滋病毒检测的接受率达到92.9%。在决定进行艾滋病毒检测的妇女中，1588人（74.3%）返回领取检测结果。艾滋病毒总体流行率为20.4%（n = 437）；326名艾滋病毒呈阳性的妇女接受了咨询，104人（24%）接受了完整的母婴抗逆转录病毒预防治疗。
自项目启动以来，咨询后艾滋病毒检测的可接受性一直保持在90%以上。检测结果的收集和母婴随访是该项目最具挑战性的活动之一。即使有相当良好的MCH服务，采用地区性方法和社区参与对于在农村地区开展PMTCT项目至关重要。
