Bajunirwe Francis, Muzoora Michael
Department of Community Health, Mbarara University of Science and Technology, PO BOX 1410, Mbarara, Uganda.
AIDS Res Ther. 2005 Oct 28;2:10. doi: 10.1186/1742-6405-2-10.
Implementation of programs for the prevention of mother-to-child transmission (PMTCT) of HIV faces a variety of barriers and challenges. The assessment of these challenges has generally been conducted in large urban health facilities. As programs expand into rural areas, the potential barriers that may be encountered there also need to be assessed. This study examines potential barriers that might affect the acceptability of interventions for PMTCT in rural and urban settings.
Four hundred and four women at a large urban hospital and three rural clinics that had recently started implementing PMTCT were interviewed. Level of knowledge of MTCT and preference for rapid HIV testing were equally high in both areas, but rural women had a higher tendency to think that they should consult their husbands before testing, with borderline statistical significance (72% vs. 64% p = 0.09). Health facility-based deliveries were significantly lower among mothers in rural areas compared to those in the urban setting. Overall, significant predictors of willingness to test for HIV were post-primary education (OR = 3.1 95% CI 1.2, 7.7) and knowledge about rapid HIV tests (OR = 1.8, 95% CI 1.01, 3.4). The strongest predictor of willingness to accept an HIV test was the woman's perception that her husband would approve of her testing for HIV. Women who thought their husbands would approve were almost six times more likely to report a willingness to be tested compared to those who thought their husbands would not approve (OR = 5.6, 95% CI 2.8, 11.2).
Lessons learned in large urban hospitals can be generalized to rural facilities, but the lower proportion of facility-based deliveries in rural areas needs to be addressed. Same-day results are likely to ensure high uptake of HIV testing services but male spousal involvement should be considered, particularly for rural areas. Universal Primary Education will support the success of PMTCT programs.
预防艾滋病母婴传播（PMTCT）项目的实施面临着各种障碍和挑战。对这些挑战的评估通常在大型城市卫生设施中进行。随着项目扩展到农村地区，也需要评估在那里可能遇到的潜在障碍。本研究调查了可能影响农村和城市地区PMTCT干预措施可接受性的潜在障碍。
对一家大型城市医院以及三家最近开始实施PMTCT的农村诊所的404名妇女进行了访谈。两个地区对母婴传播的知晓程度以及对快速艾滋病毒检测的偏好同样高，但农村妇女更倾向于认为她们在检测前应该咨询丈夫，具有边缘统计学意义（72%对64%，p = 0.09）。与城市地区相比，农村地区母亲在医疗机构分娩的比例显著更低。总体而言，接受艾滋病毒检测意愿的显著预测因素是小学后教育程度（OR = 3.1，95% CI 1.2，7.7）以及对快速艾滋病毒检测的了解（OR = 1.8，95% CI 1.01，3.4）。接受艾滋病毒检测意愿的最强预测因素是女性认为其丈夫会批准她进行艾滋病毒检测。认为丈夫会批准的女性报告愿意接受检测的可能性几乎是认为丈夫不会批准的女性的六倍（OR = 5.6，95% CI 2.8，11.2）。
在大型城市医院吸取的经验教训可推广到农村医疗机构，但农村地区医疗机构分娩比例较低的问题需要得到解决。当日出结果可能会确保艾滋病毒检测服务的高接受率，但应考虑男性配偶的参与，特别是在农村地区。普及初等教育将有助于PMTCT项目的成功。
