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Achieving HIV Epidemic Control and Improving Maternal Healthcare Services with Community-Based HIV Service Delivery in Zambia: Mixed-Methods Assessment of the SMACHT Project.

AIDS and Behavior(2023)

University of Maryland School of Medicine | Maryland Global Initiatives Corporation Zambia | Ciheb Zambia | University of Maryland College Park | U.S. Centers for Disease Control and Prevention | Southern Provincial Health Office | Boston University School of Public Health | The Hospital for Sick Children

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Abstract
Novel community-based approaches are needed to achieve and sustain HIV epidemic control in Zambia. Under the Stop Mother and Child HIV Transmission (SMACHT) project, the Community HIV Epidemic Control (CHEC) differentiated service delivery model used community health workers to support HIV testing, ART linkage, viral suppression, and prevention of mother-to-child transmission (MTCT). A multi-methods assessment included programmatic data analysis from April 2015 to September 2020, and qualitative interviews from February to March 2020. CHEC provided HIV testing services to 1,379,387 clients; 46,138 were newly identified as HIV-positive (3.3% yield), with 41,366 (90%) linked to ART. By 2020, 91% (60,694/66,841) of clients on ART were virally suppressed. Qualitatively, healthcare workers and clients benefitted from CHEC, with provision of confidential services, health facility decongestion, and increased HIV care uptake and retention. Community-based models can increase uptake of HIV testing and linkage to care, and help achieve epidemic control and elimination of MTCT.
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PBFW,PMTCT,Test & start,HIV,Differentiated service delivery,Sub-Saharan Africa
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要点】:本文介绍了在赞比亚通过社区为基础的HIV服务传递模式(SMACHT项目),有效控制HIV疫情并提高孕产妇医疗服务质量,其创新点在于采用社区健康工作者支持HIV检测、抗逆转录病毒治疗(ART)的连接、病毒抑制以及预防母婴传播(MTCT)的差异化服务模式。

方法】:研究采用了混合方法评估,包括2015年4月至2020年9月的项目数据分析和2020年2月至3月的定性访谈。

实验】:在CHEC模式下,社区HIV服务传递为1,379,387名客户提供了HIV检测服务,其中46,138名新确定为HIV阳性(3.3%的阳性率),并有41,366人(90%)成功连接到ART治疗。到2020年,91%(60,694/66,841)接受ART治疗的客户实现了病毒抑制。定性的反馈表明,社区健康工作者和客户都从CHEC中受益,包括提供保密服务、减轻卫生设施拥挤状况、提高HIV护理的接受度和保持率。文中未提及具体的数据集名称。