Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
J Acquir Immune Defic Syndr. 2013 May 1;63(1):e9-e15. doi: 10.1097/QAI.0b013e31828a3e3f.
Without treatment, approximately half of HIV-infected infants die by age 2 years, and 80% die before age 5 years. Early identification of HIV-infected and HIV-exposed infants provides opportunities for life-saving interventions. We evaluated integration of HIV-related services with routine infant immunization in Tanzania.
During April 2009 to March 2010, at 4 urban and 4 rural sites, mothers' HIV status was determined at first-month immunization using antenatal cards. HIV-exposed infants were offered HIV testing and follow-up care. Impact of integrated service delivery was assessed by comparing average monthly vaccine doses administered during the study period and a 2-year baseline period; acceptance was assessed by interviewing mothers and service providers.
During 7569 visits, 308 HIV-exposed infants were identified and registered; of these, 290 (94%) were tested, 15 (5%) were HIV infected. At urban sites, first-month vaccine doses remained stable (+2% for pentavalent vaccine and -4% for polio vaccine), and vaccine doses given later in life (pentavalent, polio, and measles) increased 12%, 8%, and 11%, respectively. At rural sites, first-month vaccine doses decreased 33% and 35% and vaccine doses given later in life decreased 23%, 28%, and 28%. Mothers and service providers generally favored integrated services; however, HIV-related stigma and inadequate confidentiality controls of HIV testing were identified, particularly at rural sites.
Integration of HIV-related services at immunization visits identified HIV-exposed infants, HIV-infected infants, and HIV-infected mothers; however, decreases in vaccine doses administered at rural sites were concerning. HIV-related service integration with immunization visits needs careful monitoring to ensure optimum vaccine delivery.
未经治疗，约有一半感染艾滋病毒的婴儿会在 2 岁前死亡，80%的婴儿会在 5 岁前死亡。早期发现感染艾滋病毒和接触过艾滋病毒的婴儿，为拯救生命的干预措施提供了机会。我们评估了坦桑尼亚将艾滋病毒相关服务与常规婴儿免疫相结合的情况。
在 2009 年 4 月至 2010 年 3 月期间，在 4 个城市和 4 个农村地点，利用产前卡在婴儿首次接种疫苗时确定母亲的艾滋病毒状况。为接触过艾滋病毒的婴儿提供艾滋病毒检测和后续护理。通过比较研究期间和 2 年基线期间平均每月接种疫苗的剂量来评估综合服务提供的效果；通过访谈母亲和服务提供者来评估接受情况。
在 7569 次就诊中，发现并登记了 308 名接触过艾滋病毒的婴儿；其中，290 名（94%）接受了检测，15 名（5%）感染了艾滋病毒。在城市地区，第一个月的疫苗剂量保持稳定（五联疫苗增加 2%，脊髓灰质炎疫苗减少 4%），而生命后期（五联疫苗、脊髓灰质炎疫苗和麻疹疫苗）的疫苗剂量分别增加了 12%、8%和 11%。在农村地区，第一个月的疫苗剂量减少了 33%和 35%，生命后期的疫苗剂量减少了 23%、28%和 28%。母亲和服务提供者普遍赞成综合服务；然而，在农村地区发现了与艾滋病毒相关的耻辱和艾滋病毒检测的保密控制不足等问题。
在免疫接种时将艾滋病毒相关服务纳入，可以发现接触过艾滋病毒的婴儿、感染艾滋病毒的婴儿和感染艾滋病毒的母亲；然而，农村地区疫苗接种剂量的减少令人担忧。需要仔细监测艾滋病毒相关服务与免疫接种的结合，以确保最佳疫苗接种。
