Mugasha Christine, Kigozi Joanita, Kiragga Agnes, Muganzi Alex, Sewankambo Nelson, Coutinho Alex, Nakanjako Damalie
Infectious Disease Institute, Kampala, Uganda.
Makerere University College of Health Sciences, Kampala, Uganda.
PLoS One. 2014 Dec 29;9(12):e115171. doi: 10.1371/journal.pone.0115171. eCollection 2014.
Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT) and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID) to inform strategic scale up of PMTCT programs.
A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI). HIV-infected pregnant mothers, identified through routine antenatal care (ANC) and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery.
Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26%) in rural and 743/1,025 (74%) in urban facilities. Of these 375/1,025 (37%) were linked to HIV clinics [67/267(25%) rural and 308/758(41%) urban]. Of 636 HIV-exposed babies, 193 (30%) were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636); 8/179 (4.5%)] in rural and 93/457(20.3%) in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1-3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3-15.1), p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings.
Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to antiretroviral therapy for elimination of MTCT.
对于通过预防艾滋病毒母婴传播（PMTCT）及后续的慢性艾滋病毒护理来改善母婴结局而言，使感染艾滋病毒的孕妇获得艾滋病毒护理仍然至关重要。本研究确定了与医疗机构内艾滋病毒护理及早期婴儿诊断护理（EID）相关的比例和因素，以为PMTCT项目的战略扩大提供参考。
在传染病研究所（IDI）支持的2家城市和3家农村公共卫生保健机构进行了记录的横断面审查。通过常规产前护理（ANC）识别出的感染艾滋病毒的孕妇母亲以及暴露于艾滋病毒的婴儿，在分娩后6周接受评估，以确定是否可纳入艾滋病毒诊所。
总体而言，2012年1月至6月期间，在ANC期间共识别出1025名感染艾滋病毒的孕妇母亲；农村地区为267/1025（26%），城市机构为743/1025（74%）。其中，375/1025（37%）与艾滋病毒诊所建立了联系[农村地区为67/267（25%），城市地区为308/758（41%）]。在636名暴露于艾滋病毒的婴儿中，193名（30%）与EID建立了联系。母婴对艾滋病毒慢性护理和EID的联系率为16%（101/636）；农村地区为8/179（4.5%），城市卫生机构为93/457（20.3%）。在农村机构中，妊娠<28周时进行ANC登记与母亲与艾滋病毒慢性护理的联系有关[调整后的比值比（AoR），2.0；95%置信区间（CI），1.1 - 3.7，p = 0.019]，母亲多胎妊娠与婴儿与EID的联系有关；AoR为4.4（1.3 - 15.1），p = 0.023。耻辱感、距离卫生机构较远以及垂直的PMTCT服务影响了农村机构中的联系，而同伴母亲、婴儿喂养服务、患者排队时间长和隐私有限则阻碍了城市环境中与艾滋病毒护理的联系。
感染艾滋病毒的母亲与慢性艾滋病毒护理的产后联系以及暴露于艾滋病毒的婴儿与EID项目的联系率较低。城市和农村环境中与艾滋病毒护理联系的障碍各不相同。我们建议采取有针对性的干预措施，以迅速改善抗逆转录病毒疗法的联系，从而消除母婴传播。
