*Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA; †Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania; ‡Expanded Programme on Immunizations, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania; §Reproductive Child Health Services, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania; ‖National AIDS Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania; and ¶Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.
J Acquir Immune Defic Syndr. 2014 May 1;66(1):e8-e14. doi: 10.1097/QAI.0000000000000078.
In 2009, a project was implemented in 8 primary health clinics throughout Tanzania to explore the feasibility of integrating pediatric HIV prevention services with routine infant immunization visits.
We conducted interviews with 64 conveniently sampled mothers of infants who had received integrated HIV and immunization services and 16 providers who delivered the integrated services to qualitatively identify benefits and challenges of the intervention midway through project implementation.
Mothers' perceived benefits of the integrated services included time savings, opportunity to learn their child's HIV status and receive HIV treatment, if necessary. Providers' perceived benefits included reaching mothers who usually would not come for only HIV testing. Mothers and providers reported similar challenges, including mothers' fear of HIV testing, poor spousal support, perceived mandatory HIV testing, poor patient flow affecting confidentiality of service delivery, heavier provider workloads, and community stigma against HIV-infected persons; the latter a more frequent theme in rural compared with urban locations.
Future scale-up should ensure privacy of these integrated services received at clinics and community outreach to address stigma and perceived mandatory testing. Increasing human resources for health to address higher workloads and longer waiting times for proper patient flow is necessary in the long term.
2009 年，坦桑尼亚的 8 家初级保健诊所实施了一个项目，旨在探索将儿科艾滋病毒预防服务与常规婴儿免疫接种相结合的可行性。
我们对 64 名接受过整合艾滋病毒和免疫服务的婴儿的母亲和 16 名提供整合服务的提供者进行了访谈，以便在项目实施中途定性地确定干预措施的益处和挑战。
母亲们认为整合服务的好处包括节省时间、有机会了解自己孩子的艾滋病毒状况并在必要时接受艾滋病毒治疗。提供者认为整合服务的好处包括能够接触到通常不会只为艾滋病毒检测而来的母亲。母亲和提供者报告了类似的挑战，包括母亲对艾滋病毒检测的恐惧、配偶支持不佳、认为艾滋病毒检测是强制性的、不良的患者流动影响服务提供的保密性、提供者工作量增加以及社区对艾滋病毒感染者的污名化；后者在农村地区比城市地区更为常见。
未来的扩大规模应确保在诊所和社区外展中提供这些整合服务的隐私，以解决污名化和强制性检测的问题。长期来看，增加卫生人力资源以解决更高的工作量和更长的等待时间以实现适当的患者流动是必要的。
