Closing the gaps in PMTCT program coverage, early infant diagnosis and treatment.

缩小预防母婴传播计划覆盖范围、婴儿早期诊断和治疗方面的差距。

• 批准号: 8434963
• 负责人: Mary-Ann Davies
• 金额: $ 45.5万
• 依托单位: UNIVERSITY OF CAPE TOWN
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-28 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8434963
• 关键词: African; Anti-Retroviral Agents; Blood Tests; CD4 Lymphocyte Count; Caring; Child; Clinic; Clinical; Complement; Continuity of Patient Care; Country; Data; Diagnosis; Discipline of obstetrics; Drops; Effectiveness; Electronics; Ensure; Failure; Fostering; Future; Goals; Guidelines; HIV; HIV Seropositivity; Health Services; Health system; Individual; Infant; Infant Care; Intervention; Investigation; Laboratories; Link; Modeling; Monitor; Morbidity - disease rate; Mothers; Paper; Performance; Pharmaceutical Preparations; Pregnant Women; Prevalence; Prevention; Preventive; Primary Health Care; Protocols documentation; Provider; Province; Reporting; Services; South Africa; System; Technology; Test Result; Testing; Umbilical Cord Blood; Vertical Disease Transmission; Work; antiretroviral therapy; base; design; improved; infancy; mortality; pediatric human immunodeficiency virus; postnatal; prevent; programs; public health emergency; quality assurance; therapy design; transmission process; virtual

DESCRIPTION (provided by applicant): Virtual elimination of vertical transmission of HIV is within reach in South Africa. Despite high antenatal HIV prevalence, implementation of currently available technology and guidelines in the South African Prevention of Mother-to-Child Transmission (PMTCT) program, and particularly the longstanding and comprehensive program in the Western Cape Province, South Africa, has resulted in substantial reductions in vertically transmitted HIV to 3.5% across the country, and 3.3% in the Western Cape. Yet, elimination remains elusive due to persistent coverage gaps and drop-offs at each of the steps required in completion of the PMTCT and infant care continuum, with upwards of 1000 vertically infected infants born in the Western Cape each year. Improving the performance of the current PMTCT and antiretroviral therapy (ART) guidelines at each point in the care continuum through meticulous surveillance of system failures with resultant intervention, are key to further mitigating the effect of HIV on children, irrespective of possible future introduction of different guideline and service design options. Strengthening the health system with this active surveillance approach will provide long term benefits that will both complement and endure beyond future changes in drug protocols or service delivery models. This system will foster a paradigm in which identified cases of infant HIV exposure not covered by PMTCT drugs and HIV infected infants are viewed as a public health emergency requiring urgent intervention to identify reasons for program failure and mitigate its effects in an individual child. This project focused on a primary care obstetric facility, aims to implement and evaluate three linked enhancements to the existing service platform that will iteratively identify and close all PMTCT and early infant diagnosis and ART coverage gaps. First, existing paper registers at antenatal, obstetric and infant clinics will be digitized, internally linked, and merged with laboratory data using context-appropriate technology that has been applied to other priority programs, namely ART and TB monitoring. The combined PMTCT e-register will be linked to a system of urgent reporting of laboratory results of low CD4 counts in pregnant women and positive infant HIV-PCR test results to clinics, with tracing to ensure prompt ART initiation. This will strengthen the health system to close these key PMTCT coverage gaps. Second, a system of routine cord blood testing for HIV, and, if positive, the presence of antiretroviral drugs (ARVs) will identify and link to care HIV-exposed infants with no/suboptimal peripartum ARVs to ensure interventions to prevent postnatal transmission, prompt infant diagnosis and ART if infected. Third, a program of clinical quality assurance, improvement and audit will be established. This will be based on data from both the e-register and cord blood surveillance that will generate an early warning system of coverage gaps. Using these data, PMTCT program failures will be regularly and systematically analyzed together with Provincial and Local Departments of Health service managers and providers, with a view to achieving iterative service improvements. PUBLIC HEALTH RELEVANCE: Virtual elimination of pediatric HIV, the leading cause of under 5 mortality in South Africa, is possible with current PMTCT technology and guidelines, but remains elusive due to persistent coverage gaps and missed opportunities for PMTCT, despite a longstanding and comprehensive program. Systems to strengthen and enhance the effectiveness of health service implementation of PMTCT are therefore needed. The goal of this project is to implement and evaluate a replicable active surveillance system integrated with the existing monitoring platform that aims to (i) provide an early warning system of PMTCT coverage gaps leading to iterative program performance improvements and (ii) identify and link to care pregnant women and HIV exposed and infected infants critically needing ART or interventions to prevent transmission, thus closing key gaps in the PMTCT continuum.

描述（由申请人提供）：南非的虚拟消除艾滋病毒的垂直传播已触及​​。尽管较高的产HIV患病率很高，但目前可用的技术和指南在南非预防母亲到孩子传播（PMTCT）计划中，尤其是南非西开普省的长期且全面的计划，导致全国垂直传播的艾滋病毒大幅降低至3.5％的西部凯西牛和3.3％。然而，由于在PMTCT和婴儿护理连续体完成所需的每个步骤中，由于持续的覆盖范围和下降，淘汰仍然难以捉摸，每年在西开普省出生的1000名垂直感染的婴儿超过1000名。通过精心监视系统失败的细致监视，改善当前PMTCT和抗逆转录病毒疗法（ART）指南的性能，这是进一步减轻HIV对儿童的影响的关键，而不论未来可能引入不同的指南和服务设计选项。通过这种主动监视方法加强卫生系统将提供长期的益处，既可以补充又可以忍受药物协议或服务输送模型的未来变化。该系统将促进一个范式，在该范式中，发现未经PMTCT药物涵盖的婴儿艾滋病毒暴露案件和艾滋病毒感染的婴儿被视为公共卫生紧急情况，需要紧急干预以确定程序失败的原因并减轻其对单个儿童的影响。 该项目侧重于初级保健产科设施，旨在实施和评估与现有服务平台的三个链接增强功能，这些增强功能将迭代地识别并缩小所有PMTCT和早期婴儿诊断和艺术覆盖差距。首先，将使用已应用于其他优先计划（即ART和TB监视）的上下文技术将产科，产科和婴儿诊所的现有纸登记处与实验室数据进行数字化，内部联系并与实验室数据合并。合并后的PMTCT电子注册者将与孕妇低CD4计数的实验室结果和婴儿阳性HIV-PCR测试结果的紧急报告有关，并进行了追踪，以确保迅速的艺术启动。这将加强 卫生系统缩小这些关键的PMTCT覆盖范围。其次，艾滋病毒的常规脐带血测试系统，如果阳性，抗逆转录病毒药物（ARV）的存在将确定 并链接到没有/次级腹膜ARV的护理HIV暴露的婴儿，以确保采取干预措施以防止产后传播，迅速诊断和ART（如果感染）。第三，将建立一个临床质量保证，改进和审计的计划。这将基于来自电子注册和脐带血监测的数据，该数据将产生覆盖差距的预警系统。使用这些数据，PMTCT计划失败将定期与卫生服务经理和提供商的省和地方部门一起进行，以实现迭代服务的改进。 公共卫生相关性：通过当前的PMTCT技术和准则，可以虚拟地消除南非5岁以下死亡率的小儿艾滋病毒的主要原因，但由于持续的覆盖差距和错过的PMTCT机会，尽管有一个长期且全面的计划，但由于持续的覆盖范围和错过的机会，因此仍然难以捉摸。因此，需要加强和增强PMTCT卫生服务实施有效性的系统。 The goal of this project is to implement and evaluate a replicable active surveillance system integrated with the existing monitoring platform that aims to (i) provide an early warning system of PMTCT coverage gaps leading to iterative program performance improvements and (ii) identify and link to care pregnant women and HIV exposed and infected infants critically needing ART or interventions to prevent transmission, thus closing key gaps in the PMTCT continuum.