Institute of Tropical Medicine, Department of Microbiology, Antwerp, Belgium.
J Acquir Immune Defic Syndr. 2011 Jul 1;57(3):e47-55. doi: 10.1097/QAI.0b013e318216d5cf.
To describe the implementation and results of the linked response (LR) in Cambodia after 18 months of follow-up.
The main objectives of the LR are to increase access to sexually transmitted infection/HIV prevention, testing, care, and treatment and to strengthen existing reproductive health services through increased linkages within and between public health facilities and community-based services. The LR was piloted in Cambodia in 2008, in 2 demonstration projects, covering 5 operational districts. Routine data were collected and analyzed before (2007), during (2008), and after (2009) the implementation of the LR.
Overall in the 5 operational districts, the proportion of pregnant women, tested for HIV increased from 6% (1261 of 21,376) in 2007 to 86% (18394 of 21,478) in 2009. Syphilis testing, introduced early 2009, reached similar (85%) coverage as HIV by the end of 2009. Between 2007 and 2009, reproductive indicators also increased: antenatal care coverage (at least 1 visit) from 80% to 100%, public health facility delivery rates from 26% to 46%, and contraceptive prevalence from 24% to 28%. Antiretroviral uptake was high among HIV-positive mothers and exposed infants, 84% and 95% respectively, and 3 of 36 (8%) infants tested so far for HIV were diagnosed positive. However, 6 maternal (HIV-positive women) and 7 child deaths (1 tested positive) occurred during the pregnancy or the 30-week postpartum follow-up period.
Sexually transmitted infection/HIV indicators and follow-up dramatically improved after the LR was implemented. Efforts should be pursued to further improve quality of health care services.
描述柬埔寨在开展 18 个月的后续行动后，链接反应（LR）的实施和结果。
LR 的主要目标是通过增加公共卫生设施和社区服务之间和内部的联系，增加性传播感染/艾滋病毒预防、检测、护理和治疗的机会，并加强现有的生殖健康服务。LR 于 2008 年在柬埔寨进行试点，在 2 个示范项目中，覆盖 5 个业务区。在实施 LR 之前（2007 年）、期间（2008 年）和之后（2009 年）收集和分析了常规数据。
在 5 个业务区中，接受 HIV 检测的孕妇比例从 2007 年的 6%（21376 人中的 1261 人）上升到 2009 年的 86%（21478 人中的 18394 人）。梅毒检测于 2009 年初推出，到 2009 年底，其覆盖率与 HIV 相似（85%）。2007 年至 2009 年期间，生殖指标也有所增加：产前保健覆盖率（至少 1 次就诊）从 80%上升到 100%，公共卫生机构分娩率从 26%上升到 46%，避孕药具使用率从 24%上升到 28%。艾滋病毒阳性母亲和受感染婴儿的抗逆转录病毒药物使用率分别高达 84%和 95%，迄今为止，接受检测的 36 名婴儿中有 3 名（8%）艾滋病毒检测呈阳性。然而，在妊娠或产后 30 周随访期间，有 6 名产妇（艾滋病毒阳性妇女）和 7 名儿童死亡（1 名检测呈阳性）。
实施 LR 后，性传播感染/艾滋病毒指标和后续情况显著改善。应努力进一步提高医疗保健服务质量。
