Mwapasa Victor, Joseph Jessica, Tchereni Timothy, Jousset Aurelie, Gunda Andrews
*College of Medicine, University of Malawi, Blantyre, Malawi; †Clinton Health Access Initiative (CHAI), Boston, MA; and ‡Clinton Health Access Initiative (CHAI), Lilongwe, Malawi.
J Acquir Immune Defic Syndr. 2017 Jun 1;75 Suppl 2:S123-S131. doi: 10.1097/QAI.0000000000001340.
Poor retention of mothers and HIV-exposed infants (HEIs) in HIV care threatens efforts to eliminate pediatric HIV. Novel strategies are required to address this challenge. We compared 12-month maternal and HEI postpartum retention in health facilities implementing the following HIV care delivery models: integrated HIV and maternal, neonatal, and child health services [mother-infant pair (MIP) clinics], MIP clinics plus short-text messaging service (SMS) reminders to prevent default (MIP + SMS), and standard of care (SOC).
From May 2013 to August 2016, a cluster randomized trial was conducted in rural Malawi, which randomized 30 health facilities to the 3 service delivery models. HIV+ pregnant women and HEIs were enrolled and followed up to monitor compliance with prescheduled visits and retention. Log binomial regression, using generalized estimated equation, was used to assess the impact of the models on retention.
The trial enrolled 461, 493, and 396 HIV+ pregnant women and 386, 399, and 300 HEIs into the MIP, MIP + SMS, and SOC arms, respectively. Compared with the 12-month maternal retention rate in the SOC arm (22.2%), the rates were similar in the MIP arm [19.3%, risk ratio (RR): 0.85, 95% confidence interval (CI): 0.56 to 1.30] and in the MIP + SMS arm (24.9%, RR: 1.08, 95% CI: 0.87 to 1.35). Compared with the 12-month infant retention rate in the SOC arm (9.8%), the rates were similar in the MIP arm (8.0%, RR: 0.89, 95% CI: 0.31 to 2.58) and in the MIP + SMS arm (19.5%, RR: 1.40, 95% CI: 0.85 to 2.31).
MIP and MIP + SMS service delivery models were ineffective in improving maternal and infant retention in rural Malawi.
艾滋病毒感染母亲及其暴露于艾滋病毒的婴儿（HEIs）在艾滋病毒治疗中的低留存率威胁着消除儿童艾滋病毒的努力。需要新的策略来应对这一挑战。我们比较了采用以下艾滋病毒治疗服务模式的卫生设施中，母婴产后12个月的留存情况：整合艾滋病毒与孕产妇、新生儿及儿童健康服务[母婴对（MIP）诊所]、MIP诊所加短信息服务（SMS）提醒以防止失访（MIP + SMS）以及标准治疗（SOC）。
2013年5月至2016年8月，在马拉维农村地区进行了一项整群随机试验，将30个卫生设施随机分配到3种服务提供模式。纳入艾滋病毒阳性孕妇和HEIs并进行随访，以监测其对预定就诊的依从性和留存情况。使用广义估计方程的对数二项回归用于评估这些模式对留存率的影响。
该试验分别将461名、493名和396名艾滋病毒阳性孕妇以及386名、399名和300名HEIs纳入MIP、MIP + SMS和SOC组。与SOC组12个月的母亲留存率（22.2%）相比，MIP组[19.3%，风险比（RR）：0.85，95%置信区间（CI）：0.56至1.30]和MIP + SMS组（24.9%，RR：1.08，95%CI：0.87至1.35）的留存率相似。与SOC组12个月的婴儿留存率（9.8%）相比，MIP组（8.0%，RR：0.89，95%CI：0.31至2.58）和MIP + SMS组（19.5%，RR：1.40，95%CI：0.85至2.31）的留存率相似。
在马拉维农村地区，MIP和MIP + SMS服务提供模式对于提高母婴留存率无效。
