Takahashi Yoshiko, Avila Susana, Correa Silvia, Cardone Karina, Fernández Mariana, Crudo Favio, Sato Miho, Aiga Hirotsugu, Hirayama Kenji, Perez Freddy, Periago Maria Victoria
School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
Faculty of Nursing, Niigata University of Health and Welfare, Niigata, Japan.
BMC Prim Care. 2024 Dec 19;25(1):430. doi: 10.1186/s12875-024-02683-z.
Mother-to-child transmission (MTCT) of Trypanosoma cruzi and hepatitis B virus (HBV) increases morbidity and disability in Latin America and the Caribbean. The tailormade comprehensive antenatal care based on the Framework for the elimination of MTCT of HIV, syphilis, hepatitis B virus (HBV), and Chagas disease (EMTCT Plus) has been implemented in the region since 2018 through a private-public partnership. This study aimed to estimate the effectiveness of the intervention in preparing MTCT of T. cruzi and hepatitis B. The study further attempted to identify the barriers to and facilitators for preventing MTCT of T. cruzi and HBV in the Gran Chaco region of Argentina and Paraguay.
Data on T. cruzi and HBV screening and treatment among pregnant women and infants were collected from antenatal care (ANC) registries between June 2018 and December 2022. A cascade-of-care analysis was applied to assess the intervention's effectiveness and identify bottlenecks. Additionally, key informant interviews were conducted for both implementors and service recipients to identify barriers to and facilitators for accessing screening and treatment using the Consolidated Framework for Implementation Research.
A total of 1,658 pregnant women were recruited, achieving 100% antenatal care coverage and screening for T. cruzi and HBV. The prevalence of T. cruzi among pregnant women was 3.3% (95%CI: 2.4-4.1%), while in newborns it was 14.0% (95% CI: 6.0-25.0). Treatment coverage for newborns infected with T. cruzi was 100%, whereas post-delivery treatment coverage among mothers was 67.3%. This achievement was likely attributed to strong community engagement, contributing to 100% ANC coverage. However, barriers such as a fragile local health system, long-term follow-up requirements, high mobile populations, cultural beliefs, and social trauma were identified in target areas.
Implementing the EMTCT Plus Framework improved access to quality ANC in the study area. Nevertheless, continuous follow-up for T. cruzi screening and treatment for post-delivery remains challenging. To improve access to healthcare and ensure the sustainability of the intervention, an intercultural approach that empowers the community, alongside efforts to strengthen the local health system, is recommended.
克氏锥虫和乙型肝炎病毒（HBV）的母婴传播（MTCT）增加了拉丁美洲和加勒比地区的发病率和残疾率。自2018年以来，该地区通过公私伙伴关系实施了基于消除HIV、梅毒、乙型肝炎病毒（HBV）和恰加斯病母婴传播框架（EMTCT Plus）的量身定制的全面产前护理。本研究旨在评估该干预措施在预防克氏锥虫和乙型肝炎母婴传播方面的有效性。该研究还试图确定阿根廷和巴拉圭格兰查科地区预防克氏锥虫和HBV母婴传播的障碍和促进因素。
收集2018年6月至2022年12月期间产前护理（ANC）登记处中孕妇和婴儿的克氏锥虫和HBV筛查及治疗数据。采用级联护理分析来评估干预措施的有效性并确定瓶颈。此外，还对实施者和服务接受者进行了关键信息访谈，以使用实施研究综合框架确定获得筛查和治疗的障碍和促进因素。
共招募了1658名孕妇，实现了100%的产前护理覆盖以及克氏锥虫和HBV筛查。孕妇中克氏锥虫的患病率为3.3%（95%CI：2.4-4.1%），而新生儿中的患病率为14.0%（95%CI：6.0-25.0）。感染克氏锥虫的新生儿的治疗覆盖率为100%，而母亲产后的治疗覆盖率为67.3%。这一成就可能归因于强大的社区参与，促成了100%的产前护理覆盖。然而，在目标地区发现了一些障碍，如脆弱的当地卫生系统、长期随访要求、高流动人群、文化信仰和社会创伤。
实施EMTCT Plus框架改善了研究地区获得优质产前护理的机会。然而，对克氏锥虫筛查和产后治疗的持续随访仍然具有挑战性。为了改善医疗服务的可及性并确保干预措施的可持续性，建议采用一种增强社区权能的跨文化方法，同时努力加强当地卫生系统。
