Bancheno Wouhabe Marai, Mwanyumba Fabian, Mareverwa Joyce
Department of Obstetrics and Gyaecology, Good Shepherd Hospital, Siteki, Swaziland.
AIDS Care. 2010 Sep;22(9):1130-5. doi: 10.1080/09540121003615079.
To mitigate the negative impacts of HIV infection on pregnant women and their children, comprehensive services to prevent mother to child transmission are required. We report the outcomes and challenges of a comprehensive service to prevent mother to child transmission of HIV infection implemented from January to December 2007 in a referral hospital and its rollout clinics in rural Swaziland, Southern Africa. We reviewed monthly reports, hospital registers, and field diaries and interviewed 64 service providers. A total of 460 HIV tests were done on first and repeat antenatal care visits. From the test done, 93.7% of the results were collected. About 69.1% of first-time visitors accepted HIV test. The antenatal coverage of pregnant women with nevirapine (NVP)+/-zidovudine (AZT) was 100%. Of 443 antenatal and post-natal care women who underwent CD4 test, 54.4% collected results. About 16.3% of those who collected results were started on antiretroviral treatment. The percentage of postpartum women discharged with unknown HIV status fell by 64.8%. About 91.5% of HIV-positive women received intrapartum antiretroviral prophylaxis of stat dose NVP and AZT + lamivudine with 1-week postpartum tail. From the exposed newborns, 98.8% received NVP stat dose and AZT. A total of 304 HIV exposed infants of age six weeks to 18 months underwent DNA-PCR test. The prevalence of infection among infants where both mother and infant received antiretroviral prophylaxis was 16.1% (n=243). HIV test acceptance rate at first antenatal care visit, proportion of clients collecting CD4 and DNA-PCR test results were low and call for mechanisms for improvement. The proportion of DNA-PCR-positive exposed infants in this study was higher than other reports from Southern Africa. The variation of the findings could be explained by mode of infant feeding, age of testing and mode of delivery. Provision of comprehensive prevention of mother to child transmission services in resource limited setting is possible but challenged by staff shortage, socio-economic and service-related factors.
为减轻艾滋病毒感染对孕妇及其子女的负面影响，需要提供全面的预防母婴传播服务。我们报告了2007年1月至12月在非洲南部斯威士兰农村的一家转诊医院及其下属诊所实施的全面预防艾滋病毒母婴传播服务的成果和挑战。我们查阅了月度报告、医院登记册和实地日记，并采访了64名服务提供者。在首次和重复产前检查中共进行了460次艾滋病毒检测。已完成检测结果的收集率为93.7%。约69.1%的首次就诊者接受了艾滋病毒检测。孕妇接受奈韦拉平（NVP）+/-齐多夫定（AZT）的产前覆盖率为100%。在443名接受CD4检测的产前和产后护理妇女中，54.4%的人拿到了检测结果。拿到结果的人中约16.3%开始接受抗逆转录病毒治疗。艾滋病毒感染状况不明就出院的产后妇女比例下降了64.8%。约91.5%的艾滋病毒阳性妇女在分娩时接受了单剂量NVP和AZT+拉米夫定的抗逆转录病毒药物预防，并在产后1周继续用药。在暴露于艾滋病毒的新生儿中，98.8%的婴儿接受了单剂量NVP和AZT。共有304名年龄在6周至18个月的艾滋病毒暴露婴儿接受了DNA-PCR检测。母亲和婴儿均接受抗逆转录病毒药物预防的婴儿中，感染率为16.1%（n=243）。首次产前检查时的艾滋病毒检测接受率、接受CD4和DNA-PCR检测结果的服务对象比例较低，需要改进相关机制。本研究中DNA-PCR检测呈阳性的暴露婴儿比例高于非洲南部的其他报告。这些结果的差异可能是由婴儿喂养方式、检测年龄和分娩方式造成的。在资源有限的环境中提供全面的预防母婴传播服务是可行的，但受到人员短缺、社会经济和与服务相关因素的挑战。
