Wiegert Katherine, Dinh Thu-Ha, Mushavi Angela, Mugurungi Owen, Kilmarx Peter H
US Centers for Disease Control and Prevention -Hubert Global Health Fellow, Atlanta, Georgia, United States of America; Duke University Medical Center, Durham, North Carolina, United States of America.
US Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America.
PLoS One. 2014 Jun 10;9(6):e98236. doi: 10.1371/journal.pone.0098236. eCollection 2014.
We assessed the integration of PMTCT services during the postpartum period including early infant diagnosis of HIV (EID) and adult and pediatric antiretroviral therapy (ART) in maternal and child health (MCH) facilities in Zimbabwe.
From August to December 2012 we conducted a cross-sectional survey of a nationally representative sample of 151 MCH facilities. A questionnaire was used to survey each site about staff training, dried blood spot sample (DBS) collection, turnaround time (TAT) for test results, PMTCT services, and HIV care and treatment linkages for HIV-infected mothers and children and HIV-exposed infants. Descriptive analyses were used. Of the facilities surveyed, all facilities were trained on DBS collection and 92% responded. Approximately, 99% of responding facilities reported providing DBS collection and a basic HIV-exposed infant service package including EID, extended nevirapine prophylaxis, and use of cotrimoxazole. DBS collection was integrated with immunisations at 83% of facilities, CD4 testing with point-of-care machines was available at 37% of facilities, and ART for both mothers and children was provided at 27% of facilities. More than 80% of facilities reported that DBS test results take >4 weeks to return; TAT did not have a direct association with any specific type of transport, distance to the lab, or intermediate stops for data to travel.
Zimbabwe has successfully scaled up and integrated the national EID and PMTCT programs into the existing MCH setting. The long TAT of infant DBS test results and the lack of integrated ART programs in the MCH setting could reduce effectiveness of the national PMTCT and ART programs. Addressing these important gaps will support successful implementation of the 2014 Zimbabwe's PMTCT guidelines under which all HIV-infected pregnant and breastfeeding women will be offered life-long ART and decentralized ART care.
我们评估了津巴布韦妇幼保健（MCH）机构产后预防母婴传播（PMTCT）服务的整合情况，包括婴儿早期HIV诊断（EID）以及成人和儿童抗逆转录病毒治疗（ART）。
2012年8月至12月，我们对151家具有全国代表性的妇幼保健机构进行了横断面调查。通过问卷调查每个机构的 staff培训、干血斑样本（DBS）采集、检测结果周转时间（TAT）、PMTCT服务以及HIV感染母亲和儿童及HIV暴露婴儿的HIV护理和治疗联系情况。采用描述性分析方法。在接受调查的机构中，所有机构都接受了DBS采集培训，92%做出了回应。约99%做出回应的机构报告提供DBS采集以及包括EID、延长奈韦拉平预防用药和使用复方新诺明在内的基本HIV暴露婴儿服务包。83%的机构将DBS采集与免疫接种整合，37%的机构配备了即时检验（POC）机器进行CD4检测，27%的机构为母亲和儿童提供ART。超过80%的机构报告DBS检测结果需要>4周才能返回；TAT与任何特定类型的运输方式、到实验室的距离或数据传输的中间站点均无直接关联。
津巴布韦已成功扩大并将国家EID和PMTCT项目整合到现有的妇幼保健体系中。婴儿DBS检测结果周转时间长以及妇幼保健机构缺乏整合的ART项目可能会降低国家PMTCT和ART项目的有效性。解决这些重要差距将有助于成功实施2014年津巴布韦的PMTCT指南，根据该指南，所有HIV感染的孕妇和哺乳期妇女将获得终身ART以及分散式ART护理。
