某艾滋病高流行地区孕产期HIV抗体筛查成本效果分析

目的 分析艾滋病高流行地区孕产期人类免疫缺陷病毒(HIV)抗体筛查的经济学效率.方法 收集中国某HIV相对高流行地区2003～2006年预防艾滋病母婴传播资源投入与使用流向,以及孕产期HIV抗体筛查的实施情况及其效果,进行成本效果分析.结果 研究地区预防艾滋病母婴传播资源投入逐年增长,干预措施的支出占总投入的63.37%,孕产妇HIV抗体检测率呈逐年上升趋势(Z=31.26,P＜0.001),孕产期HIV抗体筛查例均费用为29.11元.结论 随预防母婴传播资源投入增加,孕产期HIV抗体筛查覆盖面扩大,筛查成本控制良好,具有较好的可接受性.     

预防艾滋病母婴传播资源投入影响因素分析

目的 分析艾滋病高流行地区预防母婴传播资源投入的影响因素.方法 收集我国4个艾滋病病毒相对高流行地区2003～2006年预防艾滋病母婴传播资源投入状况,运用偏相关分析方法对可能影响资源投入的6个经验因素及运用主成分分析拟合的3个综合因素进行相关分析.结果 研究地区预防艾滋病母婴传播资源投入逐年增长,与人均国内生产总值相关( P＜0.01);不同地区间资源投入有差异,与地区女性人口数(P＜0.01)、女性艾滋病病毒新报告感染水平(P＜0.01)和地区人口规模(P＜0.01)、女性艾滋病病毒感染水平(P>0.05)、服务需求(P＜0.05)等3个综合指标相关(P＜0.1).结论 研究地区预防艾滋病母婴传播资源投入受女性人口规模、女性艾滋病病毒感染水平和地区经济水平的影响.应进一步提高艾滋病母婴传播防治资源投入的合理性.     

河南省预防艾滋病母婴传播工作开展情况分析

目的了解实施艾滋病母婴传播干预措施对艾滋病病毒母婴传播的影响。方法对河南省19个项目县四年来预防艾滋病母婴传播工作、阳性妇女的管理和夫妇双方单方HIV阳性配偶随访工作情况进行统计分析。结果19个项目县1 260 435名孕产妇接受了自愿咨询检测,孕产妇检测阳性率呈现逐年下降趋势,HIV阳性育龄妇女随访率为93.00%以上,单方HIV阳性配偶随访率达到97.00%以上,接受干预措施后艾滋病母婴传播率为3.23%,整体处于低流行水平。结论通过预防艾滋病母婴传播工作的开展,减少了她们感染HIV的潜在风险,有效地避免了HIV二代传播。     

预防艾滋病母婴传播综合措施的费用效果分析

目的 对艾滋病高发地区4个预防艾滋病母婴传播项目县的预防艾滋病母婴传播综合措施进行经济学评价,探讨其费用效果及经济学效率.方法 运用项目全成本核算的方法,通过现场调查收集2003-2006年实施预防艾滋病母婴传播各项措施的费用和干预效果,计算每发现1例HIV感染孕产妇、避免1例儿奄新发感染HIV和挽救1个残疾调整寿命年(DALY)的费用.结果 孕产期每发现1例HIV感染孕产妇的费用平均为5512元(人民币),综合措施避免1例儿童HIV感染的费用为46 747元(人民币),挽同1个DALY的费用为1870元(人民币),折合231美元.结论 项目地区预防艾滋病母婴传播干预措施费用低,经济学效率较高.     

某县预防艾滋病母婴传播技术培训资源投入与利用

目的:分析某艾滋病高流行县预防母婴传播技术培训资源投入与利用情况。方法:收集研究地区2003～2006年预防艾滋病母婴传播技术培训资源投入情况,随机选取4所二级医疗机构和4所乡卫生院,收集人员培训信息,计算例均培训费用;运用χ2检验,比较培训覆盖率差异。结果:研究地区共计投入51.72万元用于预防艾滋病母婴传播技术培训,投入逐年增长,培训4571人次,县级培训人次占63.27%;例均培训费用为113.15元。二级医疗机构和乡级医疗机构培训覆盖率分别为62.77%和52.66%,二者之间差异有统计学意义。同一级别医疗机构中,不同技术类别服务提供者接受培训的比例有差异,妇产科护士受训比例最低(P<0.001)。结论:研究地区预防艾滋病母婴传播能力建设资源的投入使得能力建设覆盖面得到了扩大。     

楚雄市2006年～2010年艾滋病母婴阻断效果分析

[目的]了解楚雄市HIV感染孕产妇流行情况及预防HIV母婴传播综合干预效果。[方法]对楚雄市2006年～2010年到辖区各医疗保健机构首诊孕产妇进行HIV筛查,对HIV感染孕产妇进行咨询、采取母婴阻断措施并跟踪随访,对母婴阻断效果进行监测分析。[结果]楚雄市孕产妇HIV阳性率呈现平稳态势,感染率0.14%左右,处于中度流行地区;孕产妇感染HIV主要传播途径是性传播;目前使用的抗病毒药物对孕妇、胎儿及婴儿均安全、有效;感染孕产妇接受综合干预措施后,母婴阻断成功率为100%。[结论]实施预防艾滋病母婴传播措施,如孕早期检测、预防用药、人工喂养等,可有效降低艾滋病母婴传播率。     

我国部分艾滋病流行地区预防艾滋病母婴传播技术培训资源投入与利用

目的分析艾滋病流行地区预防母婴传播技术培训资源投入与利用情况。方法运用方差分析、χ2检验和Logistic回归方法,分析2003～2006年项目地区预防艾滋病母婴传播技术培训资源投入变化、平均每例培训费用和培训覆盖率差异。结果项目地区共计投入99.4万元用于预防艾滋病母婴传播技术培训,投入逐年增长,培训7064人次,县级培训人次占74.73%;例均培训费用为141元,校正后省级与县级培训例均费用有差异（P〈0.01）。二级医疗机构和乡级医疗机构培训覆盖率分别为64.93%和62.86%,不同类别服务提供者接受培训的比例有差异（P〈0.01）。结论研究地区预防艾滋病母婴传播能力建设资源的投入使得能力建设覆盖面得到了扩大。     

天津市2011年度预防艾滋病、梅毒和乙肝母婴传播年度数据分析与工作进展报告

为提高人群对预防艾滋病、梅毒和乙肝母婴传播的认识,为孕产妇提供预防艾滋病、梅毒和乙肝母婴传播的综合防治服务,最大限度地减少因艾滋病、梅毒和乙肝母婴传播造成的儿童感染,改善妇女、儿童的生活质量及健康水平,天津市卫生局在2011年下发了《天津市预防艾滋病、梅毒和乙肝母婴传播工作实施方案》,明确了各级职能,加强了管理培训和质控督导,增加了政府的经费支持,以期扩大对艾滋病、梅毒、乙肝感染孕产妇的干预治疗覆盖面,提高救治水平,降低新发感染,减少母婴传播。     

大同市2009-2012年预防艾滋病母婴传播信息工作分析

目的 了解大同市预防艾滋病母婴传播工作状况,分析孕产妇人群中艾滋病的流行现状和趋势,对HIV感染孕产妇采取综合干预措施,并对HIV感染孕产妇所生的儿童进行抗病毒治疗,定期随访,分析母婴阻断情况,提出有效的干预措施指导今后的工作.方法 收集整理2009-2012年山西省大同市预防艾滋病母婴传播信息工作资料,对HIV感染孕产妇及所生儿童的抗病毒治疗情况进行回顾性分析及统计.结果 孕期HIV检测率逐年上升,检出HIV感染孕产妇6例,HIV感染孕产妇所生的儿童5例,满18个月的儿童HIV感染1例,母婴传播率为25％,失访1例.结论 孕期进行HIV检测可及早发现艾滋病感染者,可有效阻断艾滋病母婴传播的发生,降低母婴传播率,确保优生优育,保障母婴安全.因此,提高孕产妇孕期检测率需要社会各部门密切配合,加大健康教育宣传力度,提高孕早期知晓率、咨询率和检测率.     

山东省部分地区2008-2011年艾滋病母婴传播水平变化趋势

母婴传播是婴幼儿感染HIV的主要途径,艾滋病母婴传播形势日趋严重,不同国家和地区的艾滋病母婴传播水平不同。在未对艾滋病感染孕产妇及其所分娩的婴儿采取任何干预措施的情况下,艾滋病母婴传播率大约为15%～50%,但采取综合的干预措施能有效减少艾滋病母婴传播的危险,部分发达国家的艾滋病母婴传播水平甚至降至2%以下。在山东省医药卫生科技发展计划项目的支持下,山东省妇幼保健所自2008年在部分地区开展了预防艾滋病母婴传播相关研究,分析和研究近年来山东省艾滋病母婴传播水平的变化,为制定预防艾滋病母婴传播综合防治策略提供科学依据。现将研究结果报告如下。     

是否接受常规提供孕产期人类免疫缺陷病毒抗体筛查孕产妇的感染水平探索

目的 对4个艾滋病(AIDS)高发县级市的预防AIDS母婴传播综合措施进行成本-效益评价,探讨适宜提供孕产期人类免疫缺陷病毒(HIV)抗体筛查的孕产妇感染水平.方法 运用项目全成本核算的角度,通过现场调查收集2003至2006年实施预防AIDS母婴传播各项措施的费用和干预效果,计算实现项目费用与通过避免儿童感染HIV所挽回的经济损失相等时的孕产妇HIV感染水平.结果 以项目全成本的角度分析,以地区经济水平衡量,孕产期HIV感染率为0.0596%时,项目成本效益相等;如按全国人均国内生产总值计算,则人群感染率在0.036%时开展筛查,项目成本-效益守恒.结论 应适时扩大我国孕产期HIV抗体筛查服务.     

HIV epidemic control—a model for optimal allocation of prevention and treatment resources

With 33 million people living with human immunodeficiency virus (HIV) worldwide and 2.7 million new infections occurring annually, additional HIV prevention and treatment efforts are urgently needed. However, available resources for HIV control are limited and must be used efficiently to minimize the future spread of the epidemic. We develop a model to determine the appropriate resource allocation between expanded HIV prevention and treatment services. We create an epidemic model that incorporates multiple key populations with different transmission modes, as well as production functions that relate investment in prevention and treatment programs to changes in transmission and treatment rates. The goal is to allocate resources to minimize R ₀, the reproductive rate of infection. We first develop a single-population model and determine the optimal resource allocation between HIV prevention and treatment. We extend the analysis to multiple independent populations, with resource allocation among interventions and populations. We then include the effects of HIV transmission between key populations. We apply our model to examine HIV epidemic control in two different settings, Uganda and Russia. As part of these applications, we develop a novel approach for estimating empirical HIV program production functions. Our study provides insights into the important question of resource allocation for a country’s optimal response to its HIV epidemic and provides a practical approach for decision makers. Better decisions about allocating limited HIV resources can improve response to the epidemic and increase access to HIV prevention and treatment services for millions of people worldwide.     

Prevention of mother-to-child transmission of HIV in a refugee camp setting in Tanzania

Abstract

The objective of this article is to describe the results of a 2-year pilot programme implementing prevention of mother to child HIV transmission (PMTCT) in a refugee camp setting. Interventions used were: community sensitization, trainings of healthcare workers, voluntary counselling and HIV testing (VCT), infant feeding, counselling, and administration of Nevirapine. Main outcome measures include: HIV testing acceptance rates, percentage of women receiving post test counselling, Nevirapine uptake, and HIV prevalence among pregnant women and their infants. Ninety-two percent of women (n=9,346) attending antenatal clinics accepted VCT. All women who were tested for HIV received their results and posttest counselling. The HIV prevalence rate among the population was 3.2%. The overall Nevirapine uptake in the camp was 97%. Over a third of women were repatriated before receiving Nevirapine. Only 14% of male counterparts accepted VCT. Due to repatriation, parent's refusal, and deaths, HIV results were available for only 15% of infants born to HIV-infected mothers. The PMTCT programme was successfully integrated into existing antenatal care services and was acceptable to the majority of pregnant women. The major challenges encountered during the implementation of this programme were repatriation of refugees before administration of Nevirapine, which made it difficult to measure the impact of the PMTCT programme.     

Can data from programs for the prevention of mother-to-child transmission of HIV be used for HIV surveillance in Kenya?

OBJECTIVE: In Africa, HIV surveillance is conducted among antenatal clinic (ANC) attendees using unlinked-anonymous testing (UAT). In Kenya, the utility of prevention of mother-to-child transmission (PMTCT) program data for HIV surveillance was evaluated. METHODS: UAT and PMTCT data were compared at the same clinics and for the same time (2003 UAT survey) period. The HIV testing uptake for PMTCT was defined as the number of ANC attendees tested for HIV out of those who had their first ANC visit during the ANC surveillance period. Odds ratios and 95% confidence intervals were calculated to determine associations between demographic characteristics and HIV testing acceptance. RESULTS: Of 39 ANC-UAT sites, six had PMTCT data. PMTCT data were recorded across several logbooks with varying quality. For PMTCT, 2,239 women were offered HIV testing and 1,258 (56%) accepted; for UAT, 1,852 women were sampled. Median UAT-based HIV prevalence was 12.8% (range, 8.1%-26.3%) compared with 14.4% (range, 7.0%-27.2%) in PMTCT. HIV testing acceptance for PMTCT ranged from 48% to 69% across clinics, and was more likely among primigravidae than multigravidae. CONCLUSION: Because of varying PMTCT data quality and varying HIV testing acceptance for PMTCT, PMTCT-based HIV prevalence estimates cannot currently replace UAT-based estimates in Kenya.     

The impact of scaling-up prevention of mother-to-child transmission (PMTCT) of HIV infection on the human resource requirement: the need to go beyond numbers

Although the mother-to-child transmission (MTCT) contributes only 5% of transmission of HIV infection, its impact has reversed the decline in infant and child mortality rates. With antenatal service coverage of over 90%, the integration of prevention of MTCT (PMTCT) of HIV infection into the Reproductive and Child Health (RCH) services in Tanzania, this is likely to overstretch the staff capacity and undermine the already compromised quality of health care services. A retrospective study was conducted to assess the impact of integrating and scaling-up PMTCT of HIV infection into routine RCH services, on the magnitude of staff workload in RCH clinics. The study was conducted in 60 health facilities identified from five regions that had participated in the pilot phase of PMTCT implementation in the Mainland Tanzania. The average staff workload was calculated from staff-load obtained from attendance records and activity-time obtained by direct observation; and staff-time from records that were kept at the clinic. The average staff workload was found to be 50.5% (8-147%) for facilities providing PMTCT of HIV infection and 37.8% (11-82%) for facilities without PMTCT services. The average staff workload was computed on the assumption that all clients attending various antenatal clinics received PMTCT services from trained staff only and the result revealed staff workload of 87.2%. This study concludes that services for PMTCT of HIV infection can easily be scaled-up and integrated into RCH services using the already existing staff. In the wake of the human resource crisis in the health sector in developing countries, strategies to address the problem will need to go beyond numbers to address issues of staff productivity and their distribution.     

Optimal investment in a portfolio of HIV prevention programs.

OBJECTIVES: In this article, the authors determine the optimal allocation of HIV prevention funds and investigate the impact of different allocation methods on health outcomes. METHODS: The authors present a resource allocation model that can be used to determine the allocation of HIV prevention funds that maximizes quality-adjusted life years (or life years) gained or HIV infections averted in a population over a specified time horizon. They apply the model to determine the allocation of a limited budget among 3 types of HIV prevention programs in a population of injection drug users and nonusers: needle exchange programs, methadone maintenance treatment, and condom availability programs. For each prevention program, the authors estimate a production function that relates the amount invested to the associated change in risky behavior. RESULTS: The authors determine the optimal allocation of funds for both objective functions for a high-prevalence population and a low-prevalence population. They also consider the allocation of funds under several common rules of thumb that are used to allocate HIV prevention resources. It is shown that simpler allocation methods (e.g., allocation based on HIV incidence or notions of equity among population groups) may lead to alloctions that do not yield the maximum health benefit. CONCLUSIONS: The optimal allocation of HIV prevention funds in a population depends on HIV prevalence and incidence, the objective function, the production functions for the prevention programs, and other factors. Consideration of cost, equity, and social and political norms may be important when allocating HIV prevention funds. The model presented in this article can help decision makers determine the health consequences of different allocations of funds.     

艾滋病母婴传播阻断抗病毒治疗依从性及影响因素

目的:探讨艾滋病母婴传播阻断抗病毒治疗的依从性水平与主要影响因素,为制定HIV阳性孕产妇及其所生婴儿抗病毒治疗规范用药的措施提供依据。方法:在云南省5个艾滋病高发县(市、区)及一家省级保健机构对艾滋病母婴传播阻断抗病毒治疗方案的依从性进行了现况调查。结果:抗病毒治疗依从性良好者占91.0%(111/122)。影响HIV阳性孕产妇及婴儿服药依从性的主要因素为医生对HIV阳性孕产妇的态度,医患间的沟通与合作程度,方案的复杂程度,家庭人均收入,家庭支持,是否在县级及以上助产机构住院分娩,以及患者对艾滋病抗病毒治疗方案的认识,对生育的态度。结论:HIV感染孕产妇艾滋病母婴传播阻断抗病毒治疗服药依从性较好,多个因素对HIV感染孕产妇服药依从性有影响。     

Improving the coverage of the PMTCT programme through a participatory quality improvement intervention in South Africa

Background  

Despite several years of implementation, prevention of mother-to-child transmission (PMTCT) programmes in many resource poor settings are failing to reach the majority of HIV positive women. We report on a data driven participatory quality improvement intervention implemented in a high HIV prevalence district in South Africa.