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Optimizing PMTCT Service Delivery in Rural North Central Nigeria: Protocol and Design for a Cluster Randomized Study

Identifieur interne : 001A18 ( Pmc/Curation ); précédent : 001A17; suivant : 001A19

Optimizing PMTCT Service Delivery in Rural North Central Nigeria: Protocol and Design for a Cluster Randomized Study

Auteurs : Muktar H. Aliyu [États-Unis] ; Meridith Blevins [États-Unis] ; Carolyn M. Audet [États-Unis] ; Bryan E. Shepherd [États-Unis] ; Adiba Hassan [États-Unis] ; Obinna Onwujekwe [Nigeria] ; Usman I. Gebi [États-Unis, Nigeria] ; Marcia L. Kalish [États-Unis] ; Mary Lou Lindegren [États-Unis] ; Sten H. Vermund [États-Unis] ; C. William Wester [États-Unis]

Source :

RBID : PMC:3786261

Abstract

More HIV-infected women in need of services for the prevention of mother-to-child transmission of HIV (PMTCT) give birth in Nigeria than in any other nation in the world. To meet the UNAIDS/WHO goal of eliminating mother-to-child HIV transmission by 2015, multiple interventions will be required to scale up PMTCT services, especially to lower-level, rural health facilities. To address this, we are conducting a cluster-randomized controlled study to evaluate the impact and cost-effectiveness of a novel, family-focused integrated package of services for PMTCT. A systematic reassignment of patient care responsibilities coupled with the adoption of point-of-care CD4+ cell count testing could facilitate the ability of lower-cadre health providers to manage PMTCT care, including the provision and scale-up of antiretroviral therapy to pregnant women in rural settings. Additionally, as influential community members, male partners could support their partners’ uptake of and adherence to PMTCT care. We describe an innovative approach to scaling up PMTCT service provision that incorporates considerations of where and from whom women can access services (task-shifting), ease of obtaining a CD4 result (point-of-care testing), the degree of HIV service integration for HIV-infected women and their infants, and the level of family and community involvement (specifically male partner involvement). This systematic approach, if proven feasible and effective, could be scaled up in Nigeria and similar resource-limited settings as a means to accelerate progress toward eliminating mother-to-child transmission of HIV and help women with HIV infection live long, healthy lives (Trial registration: NCT01805752).


Url:
DOI: 10.1016/j.cct.2013.06.013
PubMed: 23816493
PubMed Central: 3786261

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Carolyn M. Audet
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Bryan E. Shepherd
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<nlm:aff id="A2">Department of Biostatistics, Vanderbilt University</nlm:aff>
<wicri:noCountry code="subfield">Vanderbilt University</wicri:noCountry>
</affiliation>

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<p id="P2">More HIV-infected women in need of services for the prevention of mother-to-child transmission of HIV (PMTCT) give birth in Nigeria than in any other nation in the world. To meet the UNAIDS/WHO goal of eliminating mother-to-child HIV transmission by 2015, multiple interventions will be required to scale up PMTCT services, especially to lower-level, rural health facilities. To address this, we are conducting a cluster-randomized controlled study to evaluate the impact and cost-effectiveness of a novel, family-focused integrated package of services for PMTCT. A systematic reassignment of patient care responsibilities coupled with the adoption of point-of-care CD4+ cell count testing could facilitate the ability of lower-cadre health providers to manage PMTCT care, including the provision and scale-up of antiretroviral therapy to pregnant women in rural settings. Additionally, as influential community members, male partners could support their partners’ uptake of and adherence to PMTCT care. We describe an innovative approach to scaling up PMTCT service provision that incorporates considerations of where and from whom women can access services (task-shifting), ease of obtaining a CD4 result (point-of-care testing), the degree of HIV service integration for HIV-infected women and their infants, and the level of family and community involvement (specifically male partner involvement). This systematic approach, if proven feasible and effective, could be scaled up in Nigeria and similar resource-limited settings as a means to accelerate progress toward eliminating mother-to-child transmission of HIV and help women with HIV infection live long, healthy lives (Trial registration: NCT01805752).</p>
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<name>
<surname>Audet</surname>
<given-names>Carolyn M</given-names>
</name>
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<given-names>Bryan E</given-names>
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<surname>Hassan</surname>
<given-names>Adiba</given-names>
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<name>
<surname>Onwujekwe</surname>
<given-names>Obinna</given-names>
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Vanderbilt Institute for Global Health (VIGH), Nashville, United States</aff>
<aff id="A2">
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Department of Biostatistics, Vanderbilt University</aff>
<aff id="A3">
<label>c</label>
University of Nigeria, Enugu campus, Nigeria</aff>
<aff id="A4">
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Friends in Global Health, Abuja, Nigeria</aff>
<author-notes>
<corresp id="FN1">Correspondence and reprint requests to: Muktar H Aliyu, MD, DrPH, Vanderbilt Institute for Global Health, 2525 West End Avenue, Suite 750, Nashville, TN 37203-1738, USA. Phone: +1.615.322.9374, Fax: +1.615.343.7797,
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<month>6</month>
<year>2013</year>
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<pub-date pub-type="ppub">
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<year>2013</year>
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<pub-date pub-type="pmc-release">
<day>01</day>
<month>9</month>
<year>2014</year>
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<volume>36</volume>
<issue>1</issue>
<fpage>187</fpage>
<lpage>197</lpage>
<permissions>
<copyright-statement>© 2013 Elsevier Inc. All rights reserved.</copyright-statement>
<copyright-year>2013</copyright-year>
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<abstract>
<p id="P2">More HIV-infected women in need of services for the prevention of mother-to-child transmission of HIV (PMTCT) give birth in Nigeria than in any other nation in the world. To meet the UNAIDS/WHO goal of eliminating mother-to-child HIV transmission by 2015, multiple interventions will be required to scale up PMTCT services, especially to lower-level, rural health facilities. To address this, we are conducting a cluster-randomized controlled study to evaluate the impact and cost-effectiveness of a novel, family-focused integrated package of services for PMTCT. A systematic reassignment of patient care responsibilities coupled with the adoption of point-of-care CD4+ cell count testing could facilitate the ability of lower-cadre health providers to manage PMTCT care, including the provision and scale-up of antiretroviral therapy to pregnant women in rural settings. Additionally, as influential community members, male partners could support their partners’ uptake of and adherence to PMTCT care. We describe an innovative approach to scaling up PMTCT service provision that incorporates considerations of where and from whom women can access services (task-shifting), ease of obtaining a CD4 result (point-of-care testing), the degree of HIV service integration for HIV-infected women and their infants, and the level of family and community involvement (specifically male partner involvement). This systematic approach, if proven feasible and effective, could be scaled up in Nigeria and similar resource-limited settings as a means to accelerate progress toward eliminating mother-to-child transmission of HIV and help women with HIV infection live long, healthy lives (Trial registration: NCT01805752).</p>
</abstract>
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<funding-source country="United States">National Institute of Child Health & Human Development : NICHD</funding-source>
<award-id>R01 HD075075 || HD</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
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