We analyzed national surveillance data that had been reported to the Centers for Disease Control and Prevention to elucidate the impact of recent clinical and public health efforts to further decrease the number of human immunodeficiency virus (HIV) infections and resulting morbidity caused by perinatal transmission. Long-term trends in pediatric (ages, 0-13 years), perinatal acquired immune deficiency syndrome (AIDS) cases were analyzed by log-linear Poisson regression for the period 1992-2004. Estimates for the number of perinatal HIV infections that occurred during the more recent period of 2001-2004 were developed by extrapolation from the 33 states with ongoing HIV (non-AIDS) reporting to the entire United States with the use of a probabilistic model. The number of pediatric perinatal AIDS cases that were identified decreased from 858 in 1992 to only 41 in 2004. These declines were consistent across demographic and regional subgroups. Data on the number of perinatal HIV infections suggests ongoing declines throughout the early years of the 21st century from 277 (95% CI, 224-346) in 2001 to 138 (95% CI, 96-186) in 2004. The incidence and morbidity associated with perinatal HIV infection continue to decline. To ensure that existing prevention efforts continue to achieve control of these infections, consistent methods of public health surveillance must be instituted throughout the entire United States.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:
The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement interventions.Over a period of six months, five experienced maternal-child health managers and researchers iteratively adapted and tested this systems analysis tool for pMTCT services. They prioritized components of the pMTCT cascade for inclusion, disseminated multiple versions to 27 health managers and piloted it in five facilities. Process mapping techniques were used to chart PMTCT cascade steps in these five facilities, to document antenatal care attendance, HIV testing and counseling, provision of prophylactic anti-retrovirals, safe delivery, safe infant feeding, infant follow-up including HIV testing, and family planning, in order to obtain site-specific knowledge of service delivery.
Seven pMTCT cascade steps were included in the Excel-based final tool. Prevalence calculations were incorporated as sub-headings under relevant steps. Cells not requiring data inputs were locked, wording was simplified and stepwise drop-offs and maximization functions were included at key steps along the cascade. While the drop off function allows health worker to rapidly assess how many patients were lost at each step, the maximization function details the additional people served if only one step improves to 100% capacity while others stay constant.
Our experience suggests that adaptation of a cascade analysis tool for facility-level pMTCT services is feasible and appropriate as a starting point for discussions of where to implement improvement strategies. The resulting tool facilitates the engagement of frontline health workers and managers who fill out, interpret, apply the tool, and then follow up with quality improvement activities. Research on adoption, interpretation, and sustainability of this pMTCT cascade analysis tool by frontline health managers is needed.Trial Registration: ClinicalTrials.gov NCT02023658, December 9, 2013.
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