在津巴布韦将计划生育与预防母婴传播艾滋病毒相结合。
Integrating family planning and prevention of mother to child HIV transmission in Zimbabwe.
作者信息
Sarnquist Clea C, Moyo Precious, Stranix-Chibanda Lynda, Chipato Tsungai, Kang Jennifer L, Maldonado Yvonne A
机构信息
Stanford University School of Medicine, Division of Pediatric Infectious Diseases, Menlo Park, CA, 94205, USA.
University of Zimbabwe-University of California San Francisco Collaborative Research Programme, Belgravia, Harare, Zimbabwe.
出版信息
Contraception. 2014 Mar;89(3):209-14. doi: 10.1016/j.contraception.2013.11.003. Epub 2013 Nov 12.
OBJECTIVE
The objective was to integrate enhanced family planning (FP) and prevention of mother-to-child HIV transmission services in order to help HIV-positive Zimbabwean women achieve their desired family size and spacing as well as to maximize maternal and child health.
STUDY DESIGN
HIV-positive pregnant women were enrolled into a standard-of-care (SOC, n=33) or intervention (n=65) cohort, based on study entry date, and followed for 3 months postpartum. The intervention cohort received education sessions aimed at increasing FP use and negotiation power. Both groups received care from nurses with enhanced FP training. Outcomes included FP use, FP knowledge and HIV disclosure, and were assessed with Fisher's Exact Tests, binomial tests and t tests.
RESULTS
The intervention cohort reported increased control over condom use (p=.002), increased knowledge about IUDs (p=.002), increased relationship power (p=.01) and increased likelihood of disclosing their HIV status to a partner (p=.04) and having that partner disclose to them (p=.04) when compared to the SOC cohort. Long-acting reversible contraception (LARC) use in both groups increased from ~2% at baseline to >80% at 3 months postpartum (p<.001).
CONCLUSIONS
FP and sexual negotiation skills and knowledge, as well as HIV disclosure, increased significantly in the intervention cohort. LARC uptake increased significantly in both the intervention and SOC cohorts, likely because both groups received care from nurses with enhanced FP training. Successful service integration models are needed to maximize health outcomes in resource-constrained environments; this intervention is such a model that should be replicable in other settings in sub-Saharan Africa and beyond.
IMPLICATIONS
This study provides a rigorously evaluated intervention to integrate FP education into ante- and postnatal care for HIV-positive women and also to train providers on FP. Results suggest that this intervention had significant effects on contraception use and communication with sexual partners. This intervention should be adaptable to other areas.
目的
目的是整合强化计划生育（FP）和预防母婴传播艾滋病毒服务，以帮助感染艾滋病毒的津巴布韦妇女实现她们期望的家庭规模和生育间隔，并最大限度地提高母婴健康水平。
研究设计
根据研究入组日期，将感染艾滋病毒的孕妇纳入标准护理（SOC，n = 33）或干预（n = 65）队列，并在产后随访3个月。干预队列接受旨在增加计划生育使用和谈判能力的教育课程。两组均接受了接受过强化计划生育培训护士的护理。结果包括计划生育使用情况、计划生育知识和艾滋病毒披露情况，并通过Fisher精确检验、二项式检验和t检验进行评估。
结果
与SOC队列相比，干预队列报告称在避孕套使用方面的控制权增加（p = .002）、对宫内节育器（IUD）的知识增加（p = .002）、关系权力增加（p = .01）以及向伴侣披露其艾滋病毒感染状况（p = .04）并让伴侣向她们披露（p = .04）的可能性增加。两组长效可逆避孕（LARC）的使用从基线时约2%增加到产后3个月时>80%（p<.001）。
结论
干预队列中的计划生育和性谈判技能及知识，以及艾滋病毒披露情况显著增加。干预组和SOC队列中LARC的采用率均显著增加，可能是因为两组均接受了接受过强化计划生育培训护士的护理。需要成功的服务整合模式以在资源有限的环境中最大限度地提高健康结果；这种干预就是这样一种模式，应可在撒哈拉以南非洲及其他地区的其他环境中复制。
启示
本研究提供了一项经过严格评估的干预措施，将计划生育教育纳入对感染艾滋病毒妇女的产前和产后护理，并对提供者进行计划生育培训。结果表明，这种干预对避孕使用和与性伴侣的沟通有显著影响。这种干预应可适用于其他领域。
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