Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E, Firmenich P, Humblet P
Médecins sans Frontières-Luxembourg, Thyolo district, Luxembourg, Malawi.
Trop Med Int Health. 2005 Dec;10(12):1242-50. doi: 10.1111/j.1365-3156.2005.01526.x.
Thyolo District Hospital, rural Malawi.
In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district.
Cohort study.
Review of routine antenatal, VCT and PMTCT registers.
Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available.
In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.
马拉维农村地区的蒂约洛区医院。
在预防母婴传播艾滋病毒（PMTCT）项目中，确定：提供“选择退出”式自愿咨询和艾滋病毒检测（VCT）的可接受性；艾滋病毒呈阳性的母亲在孕期、分娩时及产后6个月随访期间的随访失访情况；以及该地区错过分娩的比例。
队列研究。
审查常规产前、VCT和PMTCT登记册。
在3136名新的产前母亲中，2996名（96%，95%置信区间（CI）：95 - 97）接受了检测前咨询，2965名（95%，CI：94 - 96）接受了艾滋病毒检测，所有接受检测者均接受了检测后咨询。31名（1%）母亲拒绝接受艾滋病毒检测。共有646名（22%）个体艾滋病毒呈阳性，并被纳入PMTCT项目。288名（45%）母亲和222名（34%）婴儿接受了奈韦拉平治疗。到孕36周产前检查时，随访累计失访（n = ６46）人数为358名（55%，CI：51 - 59），到分娩时为440名（68%，CI：64 - 71），到产后首次随访时为450名（70%，CI：66 - 73），到产后6个月随访时为524名（81%，CI：78 - 84）。这使得最初队列中仅有122名（19%，CI：16 - 22）仍在该项目中。绝大多数（87%）分娩发生在无法提供PMTCT服务的周边地点。
在农村地区医院环境中，每10名接受产前服务的母亲中至少有9名接受了VCT，其中约四分之一艾滋病毒呈阳性并被纳入PMTCT项目。如果要在我们的环境中扩大PMTCT规模，到产后6个月随访时该队列四分之三以上的人逐渐失访，这就需要“采取不同的行动方式”。
