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Outcomes and challenges of scaling up comprehensive PMTCT services in rural Swaziland, Southern Africa.
AIDS Care. 2010 Sep; 22(9):1130-5.AC

Abstract

To mitigate the negative impacts of HIV infection on pregnant women and their children, comprehensive services to prevent mother to child transmission are required. We report the outcomes and challenges of a comprehensive service to prevent mother to child transmission of HIV infection implemented from January to December 2007 in a referral hospital and its rollout clinics in rural Swaziland, Southern Africa. We reviewed monthly reports, hospital registers, and field diaries and interviewed 64 service providers. A total of 460 HIV tests were done on first and repeat antenatal care visits. From the test done, 93.7% of the results were collected. About 69.1% of first-time visitors accepted HIV test. The antenatal coverage of pregnant women with nevirapine (NVP)+/-zidovudine (AZT) was 100%. Of 443 antenatal and post-natal care women who underwent CD4 test, 54.4% collected results. About 16.3% of those who collected results were started on antiretroviral treatment. The percentage of postpartum women discharged with unknown HIV status fell by 64.8%. About 91.5% of HIV-positive women received intrapartum antiretroviral prophylaxis of stat dose NVP and AZT + lamivudine with 1-week postpartum tail. From the exposed newborns, 98.8% received NVP stat dose and AZT. A total of 304 HIV exposed infants of age six weeks to 18 months underwent DNA-PCR test. The prevalence of infection among infants where both mother and infant received antiretroviral prophylaxis was 16.1% (n=243). HIV test acceptance rate at first antenatal care visit, proportion of clients collecting CD4 and DNA-PCR test results were low and call for mechanisms for improvement. The proportion of DNA-PCR-positive exposed infants in this study was higher than other reports from Southern Africa. The variation of the findings could be explained by mode of infant feeding, age of testing and mode of delivery. Provision of comprehensive prevention of mother to child transmission services in resource limited setting is possible but challenged by staff shortage, socio-economic and service-related factors.

Authors+Show Affiliations

Department of Obstetrics and Gyaecology, Good Shepherd Hospital, Siteki, Swaziland. wuhabe@yahoo.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20824565

Citation

Bancheno, Wouhabe Marai, et al. "Outcomes and Challenges of Scaling Up Comprehensive PMTCT Services in Rural Swaziland, Southern Africa." AIDS Care, vol. 22, no. 9, 2010, pp. 1130-5.
Bancheno WM, Mwanyumba F, Mareverwa J. Outcomes and challenges of scaling up comprehensive PMTCT services in rural Swaziland, Southern Africa. AIDS Care. 2010;22(9):1130-5.
Bancheno, W. M., Mwanyumba, F., & Mareverwa, J. (2010). Outcomes and challenges of scaling up comprehensive PMTCT services in rural Swaziland, Southern Africa. AIDS Care, 22(9), 1130-5. https://doi.org/10.1080/09540121003615079
Bancheno WM, Mwanyumba F, Mareverwa J. Outcomes and Challenges of Scaling Up Comprehensive PMTCT Services in Rural Swaziland, Southern Africa. AIDS Care. 2010;22(9):1130-5. PubMed PMID: 20824565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes and challenges of scaling up comprehensive PMTCT services in rural Swaziland, Southern Africa. AU - Bancheno,Wouhabe Marai, AU - Mwanyumba,Fabian, AU - Mareverwa,Joyce, PY - 2010/9/9/entrez PY - 2010/9/9/pubmed PY - 2011/2/26/medline SP - 1130 EP - 5 JF - AIDS care JO - AIDS Care VL - 22 IS - 9 N2 - To mitigate the negative impacts of HIV infection on pregnant women and their children, comprehensive services to prevent mother to child transmission are required. We report the outcomes and challenges of a comprehensive service to prevent mother to child transmission of HIV infection implemented from January to December 2007 in a referral hospital and its rollout clinics in rural Swaziland, Southern Africa. We reviewed monthly reports, hospital registers, and field diaries and interviewed 64 service providers. A total of 460 HIV tests were done on first and repeat antenatal care visits. From the test done, 93.7% of the results were collected. About 69.1% of first-time visitors accepted HIV test. The antenatal coverage of pregnant women with nevirapine (NVP)+/-zidovudine (AZT) was 100%. Of 443 antenatal and post-natal care women who underwent CD4 test, 54.4% collected results. About 16.3% of those who collected results were started on antiretroviral treatment. The percentage of postpartum women discharged with unknown HIV status fell by 64.8%. About 91.5% of HIV-positive women received intrapartum antiretroviral prophylaxis of stat dose NVP and AZT + lamivudine with 1-week postpartum tail. From the exposed newborns, 98.8% received NVP stat dose and AZT. A total of 304 HIV exposed infants of age six weeks to 18 months underwent DNA-PCR test. The prevalence of infection among infants where both mother and infant received antiretroviral prophylaxis was 16.1% (n=243). HIV test acceptance rate at first antenatal care visit, proportion of clients collecting CD4 and DNA-PCR test results were low and call for mechanisms for improvement. The proportion of DNA-PCR-positive exposed infants in this study was higher than other reports from Southern Africa. The variation of the findings could be explained by mode of infant feeding, age of testing and mode of delivery. Provision of comprehensive prevention of mother to child transmission services in resource limited setting is possible but challenged by staff shortage, socio-economic and service-related factors. SN - 1360-0451 UR - https://www.unboundmedicine.com/medline/citation/20824565/Outcomes_and_challenges_of_scaling_up_comprehensive_PMTCT_services_in_rural_Swaziland_Southern_Africa_ L2 - http://www.tandfonline.com/doi/full/10.1080/09540121003615079 DB - PRIME DP - Unbound Medicine ER -