Gamell Anna, Luwanda Lameck Bonaventure, Kalinjuma Aneth Vedastus, Samson Leila, Ntamatungiro Alex John, Weisser Maja, Gingo Winfrid, Tanner Marcel, Hatz Christoph, Letang Emilio, Battegay Manuel
Ifakara Health Institute, Ifakara, United Republic of Tanzania.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
PLoS One. 2017 Jul 12;12(7):e0181096. doi: 10.1371/journal.pone.0181096. eCollection 2017.
Strategies to improve the uptake of Prevention of Mother-To-Child Transmission of HIV (PMTCT) are needed. We integrated HIV and maternal, newborn and child health services in a One Stop Clinic to improve the PMTCT cascade in a rural Tanzanian setting.
The One Stop Clinic of Ifakara offers integral care to HIV-infected pregnant women and their families at one single place and time. All pregnant women and HIV-exposed infants attended during the first year of Option B+ implementation (04/2014-03/2015) were included. PMTCT was assessed at the antenatal clinic (ANC), HIV care and labour ward, and compared with the pre-B+ period. We also characterised HIV-infected pregnant women and evaluated the MTCT rate.
1,579 women attended the ANC. Seven (0.4%) were known to be HIV-infected. Of the remainder, 98.5% (1,548/1,572) were offered an HIV test, 94% (1,456/1,548) accepted and 38 (2.6%) tested HIV-positive. 51 were re-screened for HIV during late pregnancy and one had seroconverted. The HIV prevalence at the ANC was 3.1% (46/1,463). Of the 39 newly diagnosed women, 35 (90%) were linked to care. HIV test was offered to >98% of ANC clients during both the pre- and post-B+ periods. During the post-B+ period, test acceptance (94% versus 90.5%, p<0.0001) and linkage to care (90% versus 26%, p<0.0001) increased. Ten additional women diagnosed outside the ANC were linked to care. 82% (37/45) of these newly-enrolled women started antiretroviral treatment (ART). After a median time of 17 months, 27% (12/45) were lost to follow-up. 79 women under HIV care became pregnant and all received ART. After a median follow-up time of 19 months, 6% (5/79) had been lost. 5,727 women delivered at the hospital, 20% (1,155/5,727) had unknown HIV serostatus. Of these, 30% (345/1,155) were tested for HIV, and 18/345 (5.2%) were HIV-positive. Compared to the pre-B+ period more women were tested during labour (30% versus 2.4%, p<0.0001). During the study, the MTCT rate was 2.2%.
The implementation of Option B+ through an integrated service delivery model resulted in universal HIV testing in the ANC, high rates of linkage to care, and MTCT below the elimination threshold. However, HIV testing in late pregnancy and labour, and retention during early ART need to be improved.
需要采取策略来提高预防艾滋病母婴传播（PMTCT）的接受率。我们在一站式诊所整合了艾滋病毒与孕产妇、新生儿及儿童健康服务，以改善坦桑尼亚农村地区的PMTCT服务流程。
伊法卡拉一站式诊所为感染艾滋病毒的孕妇及其家庭在同一地点、同一时间提供综合护理。纳入了在B+方案实施的第一年（2014年4月至2015年3月）期间就诊的所有孕妇及暴露于艾滋病毒的婴儿。在产前诊所（ANC）、艾滋病毒护理及产房对PMTCT进行评估，并与B+方案实施前的时期进行比较。我们还对感染艾滋病毒的孕妇进行了特征分析，并评估了母婴传播率。
1579名妇女到ANC就诊。已知7名（0.4%）感染艾滋病毒。其余妇女中，98.5%（1548/1572）接受了艾滋病毒检测，94%（1456/1548）接受检测，38名（2.6%）检测呈艾滋病毒阳性。51名妇女在妊娠晚期重新接受了艾滋病毒筛查，1名发生了血清转化。ANC的艾滋病毒感染率为3.1%（46/1463）。在39名新诊断的妇女中，35名（90%）被转介接受护理。在B+方案实施前后，超过98%的ANC就诊者都接受了艾滋病毒检测。在B+方案实施后，检测接受率（94%对90.5%，p<0.0001）和转介接受护理率（90%对26%，p<0.0001）有所提高。另外10名在ANC以外诊断出感染艾滋病毒的妇女也被转介接受护理。这些新登记的妇女中有82%（37/45）开始接受抗逆转录病毒治疗（ART）。在中位时间17个月后，27%（12/45）失访。79名接受艾滋病毒护理的妇女怀孕，全部接受了ART。在中位随访时间19个月后，6%（5/79）失访。5727名妇女在医院分娩，20%（1155/5727）艾滋病毒血清学状态不明。其中，30%（345/1155）接受了艾滋病毒检测，18/345（5.2%）呈艾滋病毒阳性。与B+方案实施前相比，分娩时接受检测的妇女更多（30%对2.4%，p<0.0001）。在研究期间，母婴传播率为2.2%。
通过综合服务提供模式实施B+方案，在ANC实现了普遍艾滋病毒检测、高转介接受护理率，且母婴传播率低于消除阈值。然而，妊娠晚期和分娩时的艾滋病毒检测以及早期ART治疗期间的留存率仍需改善。
