Perez Freddy, Orne-Gliemann Joanna, Mukotekwa Tarisai, Miller Anna, Glenshaw Monica, Mahomva Agnes, Dabis François
Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2, 146 rue Léo-Saignat, 33076 Bordeaux, France.
BMJ. 2004 Nov 13;329(7475):1147-50. doi: 10.1136/bmj.329.7475.1147.
Zimbabwe has one of the highest rates of HIV seroprevalence in the world. In 2001 only 4% of women and children in need of services for prevention of mother to child transmission of HIV were receiving them.
Pilot implementation of the first programme for prevention of mother to child transmission of HIV in rural Zimbabwe.
120 bed district hospital in Buhera district (285,000 inhabitants), Manicaland, Zimbabwe.
Programme uptake indicators monitored for 18 months; impact of policy evaluated by assessing up-scaling of programme.
Voluntary counselling and testing services for HIV were provided in the hospital antenatal clinic. Women identified as HIV positive and informed of their serostatus and their newborn were offered a single dose antiretroviral treatment of nevirapine; mother-child pairs were followed up through routine health services. Nursing staff and social workers were trained, and community mobilisation was conducted.
No services for prevention of mother to child transmission of HIV were available at baseline. Within 18 months, 2298 pregnant women had received pretest counselling, and the acceptance of HIV testing reached 93.0%. Of all 2137 women who had an HIV test, 1588 (74.3%) returned to collect their result; 326 of the 437 HIV positive women diagnosed had post-test counselling, and 104 (24%) mother-child pairs received nevirapine prophylaxis.
Minimum staffing, an enhanced training programme, and involvement of district health authorities are needed for the implementation and successful integration of services for prevention of mother to child transmission of HIV. Voluntary counselling and testing services are important entry points for HIV prevention and care and for referral to community networks and medical HIV care services. A district approach is critical to extend programmes for prevention of mother to child transmission of HIV in rural settings. The lessons learnt from this pilot programme have contributed to the design of the national expansion strategy for prevention of mother to child transmission of HIV in Zimbabwe.
津巴布韦是全球艾滋病病毒血清阳性率最高的国家之一。2001年，在需要预防母婴传播艾滋病病毒服务的妇女和儿童中，仅有4%的人获得了此类服务。
在津巴布韦农村地区首次试点实施预防母婴传播艾滋病病毒项目。
津巴布韦马尼卡兰省布埃拉区一家拥有120张床位的区级医院（当地居民28.5万）。
对项目接受情况指标进行为期18个月的监测；通过评估项目的推广情况来评价政策的影响。
在医院产前诊所提供艾滋病病毒自愿咨询检测服务。对确诊为艾滋病病毒阳性并被告知其血清状况的妇女及其新生儿，提供单剂量奈韦拉平抗逆转录病毒治疗；通过常规卫生服务对母婴进行随访。对护理人员和社会工作者进行培训，并开展社区动员工作。
基线时不存在预防母婴传播艾滋病病毒的服务。18个月内，2298名孕妇接受了检测前咨询，艾滋病病毒检测接受率达到93.0%。在所有2137名接受艾滋病病毒检测的妇女中，1588人（74.3%）返回领取检测结果；在437名确诊为艾滋病病毒阳性的妇女中，326人接受了检测后咨询，104对母婴（24%）接受了奈韦拉平预防用药。
实施并成功整合预防母婴传播艾滋病病毒服务需要最低限度的人员配备、强化培训项目以及地区卫生当局的参与。自愿咨询检测服务是艾滋病病毒预防和护理以及转介到社区网络和艾滋病病毒医疗护理服务的重要切入点。在农村地区推广预防母婴传播艾滋病病毒项目，采用区级方法至关重要。从该试点项目中吸取的经验教训为津巴布韦全国预防母婴传播艾滋病病毒扩展战略的设计提供了帮助。
