van't Hoog Anna H, Mbori-Ngacha Dorothy A, Marum Lawrence H, Otieno Juliana A, Misore Ambrose O, Nganga Lucy W, Decock Kevin M
Centers for Disease Control and Prevention Kenya, Kisumu, Kenya.
J Acquir Immune Defic Syndr. 2005 Nov 1;40(3):344-9. doi: 10.1097/01.qai.0000160712.86580.ff.
To improve uptake in a program to prevent mother-to-child HIV transmission and describe lessons relevant for prevention of mother-to-child transmission programs in resource-poor settings.
Implementation of a pilot project that evaluates approaches to increase program uptake at health facility level at New Nyanza Provincial General Hospital, a public hospital in western Kenya, an area with high HIV prevalence. Client flow was revised to integrate counseling, HIV testing, and dispensing of single-dose nevirapine into routine antenatal services. The number of facilities providing PMCT services was expanded to increase district-wide coverage. Main outcome measures were uptake of counseling, HIV testing, nevirapine, and estimated program impact.
Uptake of counseling and testing improved from 55 to 68% (P < 0.001), nevirapine uptake from 57% to 70% (P < 0.001), and estimated program impact from 15% to 23% (P = 0.03). Aggregate reports compare well with computer-entered data.
Addressing institutional factors can improve uptake, but expected program impact remains low for several reasons, including relatively low efficacy of the intervention and missed opportunities in the labor room.
提高预防母婴传播艾滋病项目的参与率，并阐述与资源匮乏地区预防母婴传播项目相关的经验教训。
在肯尼亚西部一家公立医院——新尼扬扎省综合医院开展一个试点项目，该地区艾滋病病毒感染率很高，此项目旨在评估提高医疗机构层面项目参与率的方法。对就诊流程进行了修订，将咨询、艾滋病病毒检测以及单剂量奈韦拉平的发放纳入常规产前服务。扩大了提供预防母婴传播服务的机构数量，以提高全区的覆盖率。主要结局指标为咨询、艾滋病病毒检测、奈韦拉平的接受情况以及预估的项目影响。
咨询和检测的接受率从55%提高到了68%（P<0.001），奈韦拉平的接受率从57%提高到了70%（P<0.001），预估的项目影响从15%提高到了23%（P = 0.03）。汇总报告与计算机录入的数据比较吻合。
解决机构层面的因素能够提高接受率，但由于多种原因，包括干预措施的疗效相对较低以及产房存在错失的机会，预期的项目影响仍然较低。
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