Family Health International/Zambia Prevention, Care, and Treatment Partnership, Lusaka, Zambia.
BMC Health Serv Res. 2010 Jan 28;10:29. doi: 10.1186/1472-6963-10-29.
As in other resource limited settings, the Ministry of Health in Zambia is challenged to make affordable and acceptable PMTCT interventions accessible and available. With a 14.3% HIV prevalence, the MOH estimates over one million people are HIV positive in Zambia. Approximately 500,000 children are born annually in Zambia and 40,000 acquire the infection vertically each year if no intervention is offered. This study sought to review uptake of prevention of mother-to-child (PMTCT) services in a resource-limited setting following the introduction of context-specific interventions.
Interventions to improve PMTCT uptake were introduced into 38 sites providing PMTCT services in Zambia in July 2005. Baseline and follow up service data were collected on a monthly basis through September 2008. Data was checked for internal and external consistency using logic built into databases used for data management. Data audits were conducted to determine accuracy and reliability. Trends were analyzed pre- and post- intervention.
Uptake among pregnant women increased across the 13 quarters (39 months) of observation, particularly in the case of acceptance of counseling and HIV testing from 45% to 90% (p value = 0.00) in the first year and 99% by year 3 (p value = 0.00). Receipt of complete course of antiretroviral (ARV) prophylaxis increased from 29% to 66% (p = 0.00) in the first year and 97% by year 3 (p value = 0.00). There was also significant improvement in the percentage of HIV positive pregnant women referred for clinical care.
Uptake of PMTCT services in resource-limited settings can be improved by utilizing innovative alternatives to mitigate the effects of human resource shortage such as by providing technical assistance and mentorship beyond regular training courses, integrating PMTCT services into existing maternal and child health structures, addressing information gaps, mobilizing traditional and opinion leaders and building strong relationships with the government. These health system based approaches provide a sustainable improvement in the capacity and uptake of services.
在其他资源有限的环境中，赞比亚卫生部面临着使负担得起和可接受的预防母婴传播干预措施能够获得和普及的挑战。赞比亚的 HIV 感染率为 14.3%，卫生部估计，赞比亚有超过 100 万人 HIV 呈阳性。赞比亚每年约有 50 万名儿童出生，如果不提供干预措施，每年将有 4 万名儿童垂直感染。本研究旨在审查在资源有限的环境中，在引入具体情况干预措施后，预防母婴传播（PMTCT）服务的利用率。
2005 年 7 月，在赞比亚的 38 个提供 PMTCT 服务的地点引入了改善 PMTCT 利用率的干预措施。通过 2008 年 9 月，每月收集基线和后续服务数据。通过用于数据管理的数据库中内置的逻辑检查数据的内部和外部一致性。进行数据审核以确定准确性和可靠性。分析干预前后的趋势。
在观察的 13 个季度（39 个月）中，孕妇的利用率有所提高，特别是在接受咨询和 HIV 检测方面，从第一年的 45%增加到 90%（p 值=0.00），到第三年达到 99%（p 值=0.00）。接受完整疗程抗逆转录病毒（ARV）预防的比例从第一年的 29%增加到 66%（p=0.00），到第三年达到 97%（p 值=0.00）。HIV 阳性孕妇转诊接受临床护理的比例也显著提高。
通过利用创新的替代方法来减轻人力资源短缺的影响，如在常规培训课程之外提供技术援助和指导，将 PMTCT 服务整合到现有的母婴健康结构中，解决信息差距，动员传统和意见领袖，并与政府建立强有力的关系，可以改善资源有限环境中的 PMTCT 服务利用率。这些基于卫生系统的方法为服务能力和利用率的可持续提高提供了支持。
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