| BACKGROUND The uptake of VCT for HIV among rural pregnant women during the first and middle trimester in YUNNAN is very low. The HIV infected pregnant women cannot be detected early and prevented timely, which hold up the effective implementation of prevention of mother-to-child transmission of HIV in rural district.OBJECTIVES To explore effective interventions to promote VCT for HIV among rural pregnant women in rural YUNNAN, so as to improve the pregnant women to obtain VCT early and prevent mother-to-child transmission of HIV.METHODS Quasi-experiment was applied in this study. According to the distances from townships to the county centre and economic situation, four townships were chosen from Tengchong county, one middle epidemic district of HIV in YUNNAN, as our study sites. Two townships were matched with the other two. Baseline survey was conducted on 223 rural women after 28 weeks'gestation and with infants aged 3 months or less and 310 related people in village community in the 4 study sites in Nov, 2005. At the same time, data on HIV testing and maternal and child health was also collected. Based on the survey, 2 townships were randomized assign to intervention group, and the 2 matching township went into control group. Routine VCT was implemented in the control group as governmental requirements. Nine months comprehensive interventions were conducted in the intervention group.Based on the survey findings, comprehensive interventions were made, including:①Training village cadres and village doctors by participatory approaches,②Village cadres and doctors playing main roles in conducting multiple participatory community health education,③Developing Participatory PMTCT health education material to meet the need in rural areas,④Disseminating knowledge about PMTCT using《Maternal health handbook》,⑤"Working procedures of blood collection and transfering for HIV testing of pregnant by entering villages on fixed locations in fixed time" being made up by rural maternal and child health personnel and village doctors,⑥Providing routine VCT for HIV services for prenatal health women in antennal clinics.Evaluation survey was conducted in December 2006. The enrolling standard and sample size of surveyed subjects were as same as baseline survey. The contents of evaluation questionnaire were the baseline survey questionnaire adds health education assessment questions. Normal MCH data was collected too. The evaluation data and baseline data were analysis using t-test, Chi-square test, variance analysis and logistic regression. The effectiveness of comprehensive interventions was evaluated by changes of HIV testing rate, knowledge and attitudes of subjects.RESULTS The baseline survey showed that the HIV testing rates of pregnant women and the rate of VCT uptake among pregnant women before 28 weeks gestation were low, which were 33% and 15.2% respectively. The key indicators were balanced between the intervention group and the control group. The top correlate associated with not accepting HIV testing was "Pregnant women had the concept of HIV testing not necessary". The following correlate was "know little about VCT, for example worrying about high fees for VCT, not knowing where to access HIV testing". Multivariate logistic regression analysis indicated that having received HIV/AIDS education during prenatal healthcare, knowing counseling and screening test of HIV being free and where to get the test were associated with HIV testing for pregnant women.After the intervention, the rate of HIV testing, the rate of VCT for HIV, the rate of HIV testing before 28 weeks'gestations and the rate of VCT before 28 weeks'gestations among pregnant women were increased to 96.8%, 85.7%, 91.1%and 83.0%, respectively in intervention group. However, the corresponding rates in control group rose to 80.6%, 59.7%, 49.1% and 36.6%, respectively. The knowledge level of core indicators were higher than before, and attitude to VCT had changed positively among pregnant women and new mothers in the intervention group. But in the control group, the knowledge level of core indicators and attitude to VCT had no significant difference at the same time. In nearly one year, 72.3% of 112 surveyed pregnant women and new mothers participated in community health education, reaching 172 person-times in the intervention group. However there were only 33.9% of subjects in the control group, 62 person-times. The comprehensive intervention significantly increased knowledge level of core indicators and general knowledge of HIV/AIDS among village cadres and women of childbearing age.The core indicators scores of rural doctors and the general knowledge scores of husbands were improved. Knowledge of mothers in law of pregnant women and new mothers was not different before and after intervention. After the intervention knowledge and information of VCT in six kinds people has been increased significantly in the intervention group, but no change in the control group. The comprehensive intervention also improve the acception of HIV testing for pregnant women by mothers in law, women of childbearing age below 40 ages, rural doctors and rural cadres, and changed their moral attitude of discrimination to HIV infection in the intervention group. But their discriminatory attitudes towards to people living with HIV/AIDS were not affected. The awareness of core indicators and attitude to HIV testing among six kinds groups did not change during the past nine months in the control group. CONCLUSIONS The comprehensive intervention, applicating participatory community health education on prevention of mother-to-child transmission of HIV and providing convenient VCT services for rural pregnant women, effectively promotes the uptake of VCT in the first and middle trimester, knowledge about HIV/AIDS and PMTCT in pregnant Women, and partly changes the knowledge and attitudes on HIV/AIDS in the community related people.
|
PDF Full Text Request