Implementation and operational research : an integrated and comprehensive service delivery model to improve pediatric and maternal HIV care in rural Africa

Gamell, Anna and Glass, Tracy R. and Luwanda, Lameck B. and Mapesi, Herry and Samson, Leila and Mtoi, Tom and Nyamtema, Angelo and Muri, Lukas and Ntamatungiro, Alex and Tanner, Marcel and Hatz, Christoph and Battegay, Manuel and Letang, Emilio and Kiularco Study Group, . (2016) Implementation and operational research : an integrated and comprehensive service delivery model to improve pediatric and maternal HIV care in rural Africa. Journal of acquired immune deficiency syndromes, 73 (5). e67-e75.

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Official URL: http://edoc.unibas.ch/45214/

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Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa.; From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally. To assess the impact of this strategy, clinical characteristics and outcomes were compared between the period before (2008-2012) and during/after the implementation (2013-2014).; After the intervention, the number of mothers and children enrolled into care almost doubled. Compared with the pre-intervention period (2008-2012), in 2013-2014, children presented lower CD4% (16 vs. 16.8, P = 0.08) and more advanced disease (World Health Organization stage 3/4 72% vs. 35%, P < 0.001). The antiretroviral treatment coverage rose from 80% to 98% (P < 0.001), the lost-to-follow-up rate decreased from 20% to 11% (P = 0.002), and mortality ascertainment improved. During 2013-2014, 261 HIV-exposed infants were enrolled, and the early mother-to-child transmission rate among mother-infant pairs accessing PMTCT was 2%.; This strategy resulted in an increased number of mothers and children diagnosed and linked into care, a higher detection of children with AIDS, universal treatment coverage, lower loss to follow-up, and an early mother-to-child transmission rate below the threshold of elimination. This study documents a feasible and scalable model for family-centered HIV care in sub-Saharan Africa.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Tanner, Marcel and Hatz, Christoph and Letang Jimenez de Anta, Emilio Angel and Glass, Tracy
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Raven Press
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:09 Nov 2017 15:39
Deposited On:08 Dec 2016 10:17

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