导师母亲方案对母婴 HIV 护理保留率的影响：乌干达方案数据的二次分析。
Effect of a Mentor Mother Programme on retention of mother-baby pairs in HIV care: A secondary analysis of programme data in Uganda.
机构信息
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
PLoS One. 2019 Oct 14;14(10):e0223332. doi: 10.1371/journal.pone.0223332. eCollection 2019.
BACKGROUND
Community healthcare workers (CHWs) play an important role in promoting HIV-care retention. Notwithstanding inconsistencies in the outcomes of CHW programmes, these programmes are known to have a positive effect on retention of mother-baby pairs in HIV-care in sub-Saharan Africa.
AIM
The aim of this analysis was to assess the effect of mothers2mothers (m2m) Ugandan Mentor Mother (MM) programme on the retention of mother-baby pairs in HIV-care.
METHODS
We conducted a secondary analysis of data obtained from the m2m Uganda MM programme in nine East Central districts. The primary data was generated through a quasi-experimental study of women attending prevention of mother to child transmission of HIV (PMTCT) clinics in Uganda between January 2011 and March 2014; where those who were enrolled at PMTCT sites with the MM intervention (n = 1161) were compared with those who received standard PMCTCT services without the MM intervention (n = 1143). Frequencies and descriptive statistics were calculated for categorical and continuous measures respectively. Risk factors for retention in care were determined by clustered generalised estimating equations and reported as adjusted odds ratios (AOR) with 95% confidence intervals (95% CI).
RESULTS
Retention in the PMTCT cascade was significantly higher for mother-baby pairs in the intervention arm compared to those in the control arm across all measured time points (96.7% vs 65.8% at 6 weeks after birth, p<0.001; 81.5% vs 42% at 6 weeks after cessation of breastfeeding, p<0.001; and 71.2% vs 20.6% at 18 months after birth, p<0.001). Relative to the control group, women in the intervention group were less likely to be lost to follow up following treatment initiation (AOR 0.05, 95% CI: 0.02, 0.15). There was no difference in the proportion of the retained mother-baby pairs who received prescribed PMTCT interventions at different time points but a significantly higher number of mother-baby pairs in the intervention arm were retained at different time points.
CONCLUSION
HIV positive mothers and their HIV exposed children in the mothers2mothers Ugandan Mentor Mother programme had higher retention in HIV care at every step along the PMTCT cascade. We therefore recommend adoption of this peer-to-peer model in sub-Saharan Africa to complement retention in care strategies and health system interventions especially among priority and key populations.
背景
社区卫生工作者（CHW）在促进艾滋病毒护理保留方面发挥着重要作用。尽管 CHW 方案的结果不一致，但已知这些方案对撒哈拉以南非洲母婴对艾滋病毒护理的保留有积极影响。
目的
本分析的目的是评估母亲对母亲（m2m）乌干达导师母亲（MM）方案对艾滋病毒护理中母婴对保留的影响。
方法
我们对 m2m 乌干达 MM 方案在九个中东部地区的数据进行了二次分析。主要数据是通过对 2011 年 1 月至 2014 年 3 月期间在乌干达参加预防母婴传播艾滋病毒（PMTCT）诊所的妇女进行的准实验研究获得的；其中，在 PMTCT 地点登记接受 MM 干预的（n = 1161）与未接受 MM 干预的接受标准 PMTCTCT 服务的（n = 1143）进行比较。分别计算了分类和连续测量的频率和描述性统计数据。通过聚类广义估计方程确定了保留在护理中的危险因素，并以 95%置信区间（95%CI）报告调整后的优势比（AOR）。
结果
与对照组相比，干预组母婴在所有测量时间点的 PMTCT 级联中保留率均显著提高（出生后 6 周时为 96.7%对 65.8%，p<0.001；停止母乳喂养后 6 周时为 81.5%对 42%，p<0.001；出生后 18 个月时为 71.2%对 20.6%，p<0.001）。与对照组相比，干预组妇女在开始治疗后更不可能失去随访（AOR 0.05，95%CI：0.02，0.15）。在不同时间点接受规定的 PMTCT 干预的保留母婴对的比例没有差异，但在干预组中，不同时间点保留的母婴对数量明显更多。
结论
m2m 乌干达导师母亲方案中的艾滋病毒阳性母亲及其艾滋病毒暴露儿童在 PMTCT 级联的每一步都保持了更高的艾滋病毒护理保留率。因此，我们建议在撒哈拉以南非洲采用这种同伴模式来补充保留护理策略和卫生系统干预措施，特别是针对重点和关键人群。
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