Emory University, Atlanta, Georgia, USA.
J Int AIDS Soc. 2010 Mar 15;13:10. doi: 10.1186/1758-2652-13-10.
With the accessibility of prevention of mother to child transmission (PMTCT) services in sub-Saharan Africa, more women are being tested for HIV in antenatal care settings. Involving partners in the counselling and testing process could help prevent horizontal and vertical transmission of HIV. This study was conducted to assess the feasibility of couples' voluntary counseling and testing (CVCT) in antenatal care and to measure compliance with PMTCT.
A prospective cohort study was conducted over eight months at two public antenatal clinics in Kigali, Rwanda, and Lusaka, Zambia. A convenience sample of 3625 pregnant women was enrolled. Of these, 1054 women were lost to follow up. The intervention consisted of same-day individual voluntary counselling and testing (VCT) and weekend CVCT; HIV-positive participants received nevirapine tablets. In Kigali, nevirapine syrup was provided in the labour and delivery ward; in Lusaka, nevirapine syrup was supplied in pre-measured single-dose syringes. The main outcome measures were nurse midwife-recorded deliveries and reported nevirapine use.
In eight months, 1940 women enrolled in Kigali (984 VCT, 956 CVCT) and 1685 women enrolled in Lusaka (1022 VCT, 663 CVCT). HIV prevalence was 14% in Kigali, and 27% in Lusaka. Loss to follow up was more common in Kigali than Lusaka (33% vs. 24%, p = 0.000). In Lusaka, HIV-positive and HIV-negative women had significantly different loss-to-follow-up rates (30% vs. 22%, p = 0.002). CVCT was associated with reduced loss to follow up: in Kigali, 31% of couples versus 36% of women testing alone (p = 0.011); and in Lusaka, 22% of couples versus 25% of women testing alone (p = 0.137). Among HIV-positive women with follow up, CVCT had no impact on nevirapine use (86-89% in Kigali; 78-79% in Lusaka).
Weekend CVCT, though new, was feasible in both capital cities. The beneficial impact of CVCT on loss to follow up was significant, while nevirapine compliance was similar in women tested alone or with their partners. Pre-measured nevirapine syrup syringes provided flexibility to HIV-positive mothers in Lusaka, but may have contributed to study loss to follow up. These two prevention interventions remain a challenge, with CVCT still operating without supportive government policy in Zambia.
随着撒哈拉以南非洲地区预防母婴传播（PMTCT）服务的普及，越来越多的妇女在产前护理中接受艾滋病毒检测。让伴侣参与咨询和检测过程有助于防止艾滋病毒的水平和垂直传播。本研究旨在评估在产前保健中进行夫妻自愿咨询和检测（CVCT）的可行性，并衡量其对 PMTCT 的遵守情况。
这是一项在卢旺达基加利和赞比亚卢萨卡的两家公立产前诊所进行的前瞻性队列研究，历时八个月。共纳入了 3625 名孕妇，其中 1054 名孕妇失访。干预措施包括当天的个体自愿咨询和检测（VCT）以及周末的夫妻 CVCT；HIV 阳性参与者接受奈韦拉平片。在基加利，奈韦拉平糖浆在分娩和产房提供；在卢萨卡，奈韦拉平糖浆以预测量的单剂量注射器供应。主要结局指标是护士助产士记录的分娩情况和报告的奈韦拉平使用情况。
在八个月内，1940 名妇女在基加利（984 名 VCT，956 名 CVCT）和 1685 名妇女在卢萨卡（1022 名 VCT，663 名 CVCT）入组。基加利的 HIV 感染率为 14%，卢萨卡为 27%。基加利的失访率高于卢萨卡（33%比 24%，p=0.000）。在卢萨卡，HIV 阳性和 HIV 阴性妇女的失访率存在显著差异（30%比 22%，p=0.002）。CVCT 与降低失访率有关：在基加利，31%的夫妻对与妇女单独检测（p=0.011）；在卢萨卡，22%的夫妻对与妇女单独检测（p=0.137）。在有随访的 HIV 阳性妇女中，CVCT 对奈韦拉平的使用没有影响（基加利 86-89%；卢萨卡 78-79%）。
周末 CVCT 虽然是新的，但在两个首都城市都是可行的。CVCT 对失访的有益影响是显著的，而妇女单独或与伴侣一起检测的奈韦拉平依从性相似。在卢萨卡，预先测量的奈韦拉平糖浆注射器为 HIV 阳性母亲提供了灵活性，但可能导致研究失访。这两种预防干预措施仍然是一个挑战，CVCT 在赞比亚仍在没有政府支持政策的情况下运作。
