Programme PAC-CI, Abidjan, Cote d'Ivoire, France.
PLoS One. 2012;7(1):e29823. doi: 10.1371/journal.pone.0029823. Epub 2012 Jan 20.
Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood.
METHODOLOGY/PRINCIPAL FINDINGS: We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78% were managed by the government health system. An opt-out approach for HIV testing was used in 100% of facilities in Zambia, 63% in Cameroon, and none in Côte d'Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33-68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47; p = 0.013); patient understanding of medications score (rho = 0.51; p = 0.006); and patient satisfaction quality score (rho = 0.38; p = 0.031). PMTCT coverage was marginally correlated with the antenatal quality score (rho = 0.304; p = 0.091). Using GEE adjustment for clustering, the, antenatal quality score became more strongly associated with PMTCT coverage (p<0.001) and the PMTCT quality score and patient understanding of medications remained marginally significant.
CONCLUSIONS/RESULTS: We observed a positive relationship between an antenatal quality score and PMTCT coverage but did not identify a consistent set of variables that predicted PMTCT coverage.
人们对撒哈拉以南非洲地区与艾滋病毒母婴传播（PMTCT）有效预防覆盖率相关的卫生机构特征知之甚少。
方法/主要发现：我们在喀麦隆、科特迪瓦、南非和赞比亚开展了有 PMTCT 服务的卫生机构调查。数据通过直接观察和出口访谈收集。我们构建了综合评分来描述七个主题领域的 PMTCT 服务提供情况：产前质量、PMTCT 质量、供应品的可得性、患者满意度、患者对药物的理解和基础设施质量。我们使用 Pearson 相关性和广义估计方程（GEE）来评估综合评分、就诊总时间和选择的个别变量与分娩妇女 PMTCT 覆盖率之间的关系，因为这些变量在国家内的卫生机构中存在聚类。2008 年 7 月至 2009 年 5 月期间，我们从 32 个机构收集了数据；78%的机构由政府卫生系统管理。赞比亚 100%的机构采用了艾滋病毒检测的退出策略，喀麦隆 63%的机构采用了该策略，而科特迪瓦或南非的机构均未采用。使用 Pearson 相关性，PMTCT 覆盖率（中位数为 55%，IQR：33-68）与 PMTCT 质量评分（rho=0.51;p=0.003）、基础设施质量评分（rho=0.43;p=0.017）、就诊时间（rho=0.47;p=0.013）、患者对药物的理解评分（rho=0.51;p=0.006）和患者满意度质量评分（rho=0.38;p=0.031）呈正相关。PMTCT 覆盖率与产前质量评分呈弱相关（rho=0.304;p=0.091）。使用 GEE 调整聚类，产前质量评分与 PMTCT 覆盖率的相关性更强（p<0.001），而 PMTCT 质量评分和患者对药物的理解仍然具有边际意义。
结论/结果：我们观察到产前质量评分与 PMTCT 覆盖率之间存在正相关关系，但没有确定一组一致的变量可以预测 PMTCT 覆盖率。
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