Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Ministry of Health and Sanitation, Freetown, Sierra Leone.
BMC Infect Dis. 2018 Nov 14;18(1):566. doi: 10.1186/s12879-018-3480-3.
Prevention of mother to child transmission (PMTCT) has lowered the incidence of paediatric HIV globally. The risk of mother-to-child transmission of HIV (MTCT) remains high in Africa, where there is a high prevalence of pregnancy and poor health-seeking behaviour among young girls and women.
In this cross-sectional, mixed-methods study, we evaluated the utilization of PMTCT services and associated factors among adolescent and young postpartum mothers aged 15 to 24 years at a public urban referral hospital in Uganda. Both HIV-positive and HIV-negative participants were recruited. Utilization of PMTCT services was defined as use of the PMTCT cascade of services including ever testing for HIV, receiving HIV test results; If tested negative, subsequent retesting up to 14 weeks; If tested positive, Antiretroviral drugs (ARVs) for the mother, ARVs and septrin prophylaxis for infant, safe delivery, safer infant feeding, early infant diagnosis within 6 weeks, and linkage to treatment and care. Optimal utilization of PMTCT was defined as being up to date with utilization of PMTCT services for reported HIV status at the time of being interviewed. The overall proportion of participants who optimally utilized PMTCT services was determined using descriptive statistics. Qualitative data was analyzed manually using the content thematic approach.
Of the 418 participants, 65 (15.5%) were HIV positive. Overall, only 126 of 418 participants (30.1%) had optimally utilized PMTCT services. However, utilization of PMTCT services was better among HIV positive mothers, with 83% (54/65) having utilized the services optimally, compared to only 20% (72/353) of the HIV negative mothers (OR 18.2 (95% CI; 9.0-36.7)). The benefits of knowing ones HIV status, health of the unborn child, and counseling and support from health workers and peers, were the major factors motivating adolescent and young mothers to utilize PMTCT services, while stigma, financial constraints, non-disclosure, and lack of partner and family support were key demotivating factors.
Utilization of PMTCT services by these adolescent and young mothers was suboptimal. Special consideration should be given to adolescents and young women in the design of elimination of mother to child transmission (EMTCT) programs, to improve the utilization of PMTCT services.
预防母婴传播 (PMTCT) 已降低全球儿童 HIV 的发病率。在非洲，艾滋病毒母婴传播 (MTCT) 的风险仍然很高，那里年轻女孩和妇女普遍怀孕，寻求医疗服务的行为不佳。
在这项横断面、混合方法研究中，我们评估了在乌干达一家公立城市转诊医院的 15 至 24 岁青少年和产后母亲中，利用 PMTCT 服务的情况及其相关因素。研究招募了 HIV 阳性和 HIV 阴性的参与者。PMTCT 服务的利用被定义为利用 PMTCT 服务的级联，包括曾经接受过 HIV 检测、接受过 HIV 检测结果；如果检测结果为阴性，随后在 14 周内进行再次检测；如果检测结果为阳性，为母亲提供抗逆转录病毒药物 (ARV)、婴儿的 ARV 和磺胺甲恶唑预防药物、安全分娩、更安全的婴儿喂养、在 6 周内进行早期婴儿诊断，以及与治疗和护理的联系。PMTCT 服务的最佳利用被定义为根据接受采访时报告的 HIV 状况，及时利用 PMTCT 服务。使用描述性统计确定最佳利用 PMTCT 服务的参与者的总体比例。使用内容主题方法手动分析定性数据。
在 418 名参与者中，有 65 名（15.5%）HIV 阳性。总体而言，只有 418 名参与者中的 126 名（30.1%）最佳利用了 PMTCT 服务。然而，HIV 阳性母亲的 PMTCT 服务利用率更好，有 83%（54/65）的母亲最佳利用了这些服务，而 HIV 阴性母亲中只有 20%（72/353）（OR 18.2（95%CI；9.0-36.7））。了解自己的 HIV 状况、未出生婴儿的健康状况、以及卫生工作者和同龄人的咨询和支持，是促使青少年和年轻母亲利用 PMTCT 服务的主要因素，而耻辱感、经济限制、不披露、以及缺乏伴侣和家庭支持是主要的阻碍因素。
这些青少年和年轻母亲对 PMTCT 服务的利用不足。在制定消除母婴传播（EMTCT）方案时，应特别考虑青少年和年轻女性，以提高 PMTCT 服务的利用率。
