Department of Psychology, Stellenbosch University, Stellenbosch, Matieland, South Africa.
Trials. 2011 Nov 1;12:236. doi: 10.1186/1745-6215-12-236.
Progress towards MDG4 in South Africa will depend largely on scaling up effective prevention against mother to child transmission (PMTCT) of HIV and also addressing neonatal mortality. This imperative drives increasing focus on the neonatal period and particularly on the development and testing of appropriate models of sustainable, community-based care in South Africa in order to reach the poor. A number of key implementation gaps affecting progress have been identified. Implementation gaps for HIV prevention in neonates; implementation gaps for neonatal care especially home postnatal care; and implementation gaps for maternal mental health support. We have developed and are evaluating and costing an integrated and scaleable home visit package delivered by community health workers targeting pregnant and postnatal women and their newborns to provide essential maternal/newborn care as well as interventions for Prevention of Mother to Child Transmission (PMTCT) of HIV.
The trial is a cluster randomized controlled trial that is being implemented in Umlazi which is a peri-urban settlement with a total population of 1 million close to Durban in KwaZulu Natal, South Africa. The trial consists of 30 randomized clusters (15 in each arm). A baseline survey established the homogeneity of clusters and neither stratification nor matching was performed. Sample size was based on increasing HIV-free survival from 74% to 84%, and calculated to be 120 pregnant women per cluster. Primary outcomes are higher levels of HIV free survival and levels of exclusive and appropriate infant feeding at 12 weeks postnatally. The intervention is home based with community health workers delivering two antenatal visits, a postnatal visit within 48 hours of birth, and a further four visits during the first two months of the infants life. We are undertaking programmatic and cost effectiveness analysis to cost the intervention.
The question is not merely to develop an efficacious package but also to identify and test delivery strategies that enable scaling up, which requires effectiveness studies in a health systems context, adapting and testing Asian community-based studies in various African contexts.
南非实现千年发展目标 4 的进展在很大程度上将取决于扩大艾滋病毒母婴传播（PMTCT）的有效预防措施，同时也要解决新生儿死亡率问题。这一迫切需求推动了人们对新生儿期的日益关注，特别是在开发和测试适合南非的、以社区为基础的可持续护理模式方面，以帮助贫困人群。已经确定了一些影响进展的关键实施差距。预防新生儿艾滋病毒感染方面的实施差距；新生儿护理方面的实施差距，特别是家庭产后护理；以及孕产妇心理健康支持方面的实施差距。我们已经开发并正在评估和计算一种综合的、可扩展的家访套餐，由社区卫生工作者针对孕妇和产后妇女及其新生儿提供基本的母婴护理以及预防母婴传播（PMTCT）艾滋病毒的干预措施。
该试验是一项在 Umlazi 实施的整群随机对照试验，Umlazi 是一个拥有 100 万人口的城市周边定居点，靠近南非夸祖鲁-纳塔尔省的德班。该试验由 30 个随机集群（每个组 15 个）组成。基线调查确定了集群的同质性，既没有进行分层，也没有进行匹配。样本量基于将艾滋病毒无存活人数从 74%增加到 84%进行计算，每个集群需要 120 名孕妇。主要结果是更高水平的艾滋病毒无存活人数以及 12 周时纯母乳喂养和适当母乳喂养的比例。该干预措施是基于家庭的，社区卫生工作者提供两次产前访视、婴儿出生后 48 小时内的一次产后访视以及婴儿生命的头两个月内的另外四次访视。我们正在进行规划和成本效益分析，以计算干预措施的成本。
问题不仅仅是开发有效的一揽子计划，还包括确定和测试能够扩大规模的交付策略，这需要在卫生系统背景下进行有效性研究，适应并测试各种非洲背景下的亚洲社区为基础的研究。
