François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Harvard University, USA.
J Int AIDS Soc. 2010 Jun 23;13 Suppl 2(Suppl 2):S2. doi: 10.1186/1758-2652-13-S2-S2.
Prevention of mother to child transmission (PMTCT) programmes have traditionally been narrow in scope, targeting biomedical interventions during the perinatal period, rather than considering HIV as a family disease. This limited focus restricts programmes' effectiveness, and the opportunity to broaden prevention measures has largely been overlooked.Although prevention of vertical transmission is crucial, consideration of the family environment can enhance PMTCT. Family-centred approaches to HIV prevention and care present an important direction for preventing paediatric infections while improving overall family health. This paper reviews available literature on PMTCT programmatic models that have taken a broader or family-centred approach. We describe findings and barriers to the delivery of family-centred PMTCT and identify a number of promising new directions that may achieve more holistic services for children and families.
Literature on the effectiveness of family-centred PMTCT interventions available via PubMed, EMBASE and PsycINFO were searched from 1990 to the present. Four hundred and three abstracts were generated. These were narrowed to those describing or evaluating PMTCT models that target broader aspects of the family system before, during and/or after delivery of an infant at risk of acquiring HIV infection (N = 14).
The most common aspects of family-centred care incorporated by PMTCT studies and programme models included counselling, testing, and provision of antiretroviral treatment for infected pregnant women and their partners. Antiretroviral therapy was also commonly extended to other infected family members. Efforts to involve fathers in family-based PMTCT counselling, infant feeding counselling, and general decision making were less common, though promising. Also promising, but rare, were PMTCT programmes that use interventions to enrich family capacity and functioning; these include risk assessments for intimate partner violence, attention to mental health issues, and the integration of early childhood development services.
Despite barriers, numerous opportunities exist to expand PMTCT services to address the health needs of the entire family. Our review of models utilizing these approaches indicates that family-centred prevention measures can be effectively integrated within programmes. However, additional research is needed in order to more thoroughly evaluate their impact on PMTCT, as well as on broader family health outcomes.
预防母婴传播（PMTCT）项目传统上范围较窄，仅在围产期期间针对生物医学干预措施，而没有将 HIV 视为一种家庭疾病。这种有限的关注限制了项目的有效性，而扩大预防措施的机会在很大程度上被忽视了。
虽然预防垂直传播至关重要，但考虑家庭环境可以增强 PMTCT。以家庭为中心的 HIV 预防和护理方法是预防儿科感染同时改善整体家庭健康的重要方向。本文综述了采用更广泛或以家庭为中心方法的 PMTCT 规划模式的现有文献。我们描述了以家庭为中心的 PMTCT 提供的发现和障碍，并确定了一些有前途的新方向，这些方向可能为儿童和家庭提供更全面的服务。
通过 PubMed、EMBASE 和 PsycINFO 搜索了 1990 年至今有关以家庭为中心的 PMTCT 干预措施有效性的文献。生成了 403 篇摘要。这些摘要被缩小到那些描述或评估 PMTCT 模型的摘要，这些模型针对婴儿在感染 HIV 之前、期间和/或之后的更广泛的家庭系统方面，目标是针对风险感染 HIV 的婴儿（N=14）。
PMTCT 研究和项目模型中最常见的以家庭为中心的护理方面包括咨询、检测以及为感染的孕妇及其伴侣提供抗逆转录病毒治疗。通常也会将抗逆转录病毒疗法扩展到其他感染的家庭成员。在家庭为基础的 PMTCT 咨询、婴儿喂养咨询和一般决策中，让父亲参与的努力不太常见，但很有希望。同样有希望但很少见的是，PMTCT 项目使用干预措施来增强家庭能力和功能；这些干预措施包括亲密伴侣暴力风险评估、关注心理健康问题以及整合幼儿发展服务。
尽管存在障碍，但有许多机会扩大 PMTCT 服务以满足整个家庭的健康需求。我们对利用这些方法的模型的综述表明，以家庭为中心的预防措施可以有效地整合到方案中。然而，需要进一步的研究，以便更全面地评估它们对 PMTCT 以及更广泛的家庭健康结果的影响。
