Nelson Aurelie, Bheemraj Kalisha, Dean Sarah Schoetz, de Voux Alex, Hlatshwayo Lerato, Mvududu Rufaro, Berkowitz Natacha, Neumuller Caroline, Jacobs Shahida, Fourie Stephanie, Coates Thomas, Gail-Bekker Linda, Myer Landon, Davey Dvora Joseph
Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
Division of Infectious Diseases, Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
BMC Glob Public Health. 2024 Aug 26;2(1):57. doi: 10.1186/s44263-024-00089-8.
Although HIV vertical transmission has declined significantly in sub-Saharan Africa, incident HIV infection in pregnant and postpartum women is estimated to account for over one-third of HIV vertical transmission. Oral pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women (PBFW) is included in South African PrEP guidelines since 2021; however, integration of PrEP services within ante- and postnatal care remains limited.
Between March 2022 and September 2023, we evaluated the integration of PrEP for PBFW in eight antenatal clinics in Cape Town, South Africa, following training and mentorship of providers. We applied an adapted Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the integration of PrEP services for pregnant and breastfeeding women. Before the study, PrEP was not routinely offered. We implemented a staff didactic/practice-based training and mentorship on PrEP provision targeting PBFW. We evaluated the following: (1) Reach as the proportion of women initiating PrEP among women counselled and tested for HIV, (2) effectiveness as PrEP continuation up to 3 months by pregnant vs. breastfeeding women, (3) adoption of PrEP integration via pre- and post-training assessments and ongoing mentorship assessments, (4) implementation through clinic trends of PrEP offer over time, and (5) maintenance: continued PrEP offer 3 months following the intervention.
In 8 facilities providing ante- and postnatal care, we trained 224 healthcare providers (127 nurses and 37 counsellors). Of those, we mentored 60 nurses, midwives, and HIV counsellors working with pregnant and breastfeeding women, with 80% of nurse/midwives and 65% of counsellors scoring ≥ 80% on the final mentoring assessment. Overall, 12% of HIV-negative pregnant women started PrEP, and 41% of those continued PrEP up to 3 months. Among HIV-negative breastfeeding women, 14% initiated PrEP, and 25% continued PrEP up to 3 months. All eight facilities continued providing PrEP 3 months post intervention.
In these high HIV prevalence clinics, the proportion of pregnant and breastfeeding women initiating and continuing PrEP rapidly increased but was limited among breastfeeding women. Staff training, mentorship, and PrEP integration were well-adopted by nurses and counsellors, and services continued following the intervention. Barriers included limited HIV testing of breastfeeding mothers and need for additional PrEP-trained nurses.
尽管撒哈拉以南非洲地区的艾滋病毒垂直传播率已显著下降，但据估计，怀孕和产后妇女的新发艾滋病毒感染占艾滋病毒垂直传播的三分之一以上。自2021年起，南非的艾滋病毒暴露前预防（PrEP）指南将孕妇和哺乳期妇女纳入其中；然而，PrEP服务在产前和产后护理中的整合仍然有限。
2022年3月至2023年9月期间，在对提供者进行培训和指导后，我们评估了南非开普敦八家产前诊所中针对孕妇和哺乳期妇女的PrEP整合情况。我们应用了一个经过调整的覆盖、效果、采用、实施和维持（RE-AIM）框架来评估针对孕妇和哺乳期妇女的PrEP服务整合情况。在研究之前，PrEP并非常规提供。我们针对为孕妇和哺乳期妇女提供PrEP开展了基于员工教学/实践的培训和指导。我们评估了以下内容：（1）覆盖范围，即接受艾滋病毒咨询和检测的妇女中开始服用PrEP的妇女比例；（2）效果，即孕妇与哺乳期妇女服用PrEP持续至3个月的情况；（3）通过培训前和培训后的评估以及持续的指导评估来衡量PrEP整合的采用情况；（4）通过随时间推移PrEP提供的诊所趋势来评估实施情况；（5）维持情况：干预后3个月持续提供PrEP。
在8家提供产前和产后护理的机构中，我们培训了224名医疗保健提供者（127名护士和37名咨询师）。其中，我们指导了60名与孕妇和哺乳期妇女合作的护士、助产士和艾滋病毒咨询师，80%的护士/助产士和65%的咨询师在最终指导评估中得分≥80%。总体而言，12%的艾滋病毒阴性孕妇开始服用PrEP，其中41%持续服用PrEP至3个月。在艾滋病毒阴性的哺乳期妇女中，14%开始服用PrEP，25%持续服用PrEP至3个月。所有8家机构在干预后3个月继续提供PrEP。
在这些艾滋病毒高流行诊所中，开始和持续服用PrEP的孕妇和哺乳期妇女比例迅速增加，但在哺乳期妇女中仍然有限。护士和咨询师对员工培训、指导和PrEP整合的接受度良好，干预后服务仍在继续。障碍包括对哺乳期母亲的艾滋病毒检测有限，以及需要更多接受PrEP培训的护士。
