Hamela Gloria, Kabondo Charity, Tembo Tapiwa, Zimba Chifundo, Kamanga Esmie, Mofolo Innocent, Bulla Bertha, Sellers Christopher, Nakanga R C, Lee Clara, Martinson Francis, Hoffman Irving, van der Horst Charles, Hosseinipour Mina C
Afr J Reprod Health. 2014 Mar;18(1):27-34.
The objective of our intervention was to examine the benefits of incorporating traditional birth attendants (TBA) in HIV Prevention of Mother to Child Transmission (PMTCT) service delivery. We developed a training curriculum for TBAs related to PMTCT and current TBA roles in Malawi. Fourteen TBAs and seven TBA assistants serving 4 urban health centre catchment areas were assessed, trained and supervised. Focus group discussions with the TBAs were conducted after implementation of the program. From March 2008 to August 2009, a total of 4017 pregnant women visited TBAs, out of which 2133 (53.1%) were directly referred to health facilities and 1,884 (46.9%) women delivered at TBAs and subsequently referred. 168 HIV positive women were identified by TBAs. Of these, 86/168 (51.2%) women received nevirapine and 46/168 (27.4%) HIV exposed infants received nevirapine. The challenges in providing PMTCT services included lack of transportation for referrals and absence of a reporting system to confirm the woman's arrival at the health center. Non-disclosure of HIV status by patients to the TBAs resulted in inability to assist nevirapine uptake. TBAs, when trained and well-supervised, can supplement efforts to provide PMTCT services in communities.
我们干预措施的目的是检验在预防母婴传播艾滋病（PMTCT）服务中纳入传统接生员（TBA）的益处。我们针对马拉维的预防母婴传播艾滋病以及传统接生员目前的职责，为传统接生员制定了培训课程。对服务于4个城市健康中心集水区的14名传统接生员和7名传统接生员助手进行了评估、培训和监督。在该项目实施后，与传统接生员进行了焦点小组讨论。从2008年3月到2009年8月，共有4017名孕妇拜访了传统接生员，其中2133名（53.1%）被直接转诊到医疗机构，1884名（46.9%）妇女在传统接生员处分娩，随后被转诊。传统接生员识别出168名艾滋病毒呈阳性的妇女。其中，86/168（51.2%）名妇女接受了奈韦拉平治疗，46/168（27.4%）名艾滋病毒暴露婴儿接受了奈韦拉平治疗。提供预防母婴传播艾滋病服务面临的挑战包括转诊缺乏交通工具，以及缺乏确认妇女到达健康中心的报告系统。患者未向传统接生员透露艾滋病毒感染状况，导致无法协助其服用奈韦拉平。经过培训和良好监督的传统接生员可以补充社区提供预防母婴传播艾滋病服务的工作。
