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Abstract：
BACKGROUND: Achievement of the elimination target for mother-to-child transmission (MTCT) of HIV in selected countries has increased hope to end the HIV epidemic in children across the world. However, MTCT rates remain well above the 5% elimination target in most sub-Saharan Africa countries. These countries require innovative strategies to scale-up their interventions to end paediatric HIV. We describe how the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) consortium and the Children\'s Investment Fund Foundation (CIFF) used the critical path method to facilitate rapid expansion and optimization of 2010 and 2013 WHO PMTCT guidelines to reduce Zimbabwe\'s MTCT rate from 22% in 2010 to 6.4% in 2015.
METHODS: We analysed activities implemented and PMTCT programme data for the period before and during the EGPAF-CIFF project. The critical path method involved a cycle of collecting and analysing quarterly PMTCT indicator data and planning and implementing targeted activities to improve the PMTCT indicators. We performed a graphical trend analysis of data that measured availability of PMTCT services. Using Pearson\'s Chi2 test, we compared results of PMTCT uptake indicators at the start and end of the EGPAF-CIFF project and used regression discontinuity analysis to assess effectiveness of activities implemented to improve the PMTCT service uptake indicators.
RESULTS: Zimbabwe rolled out WHO 2010 and 2013 PMTCT guidelines in less than 1 year during the EGPAF-CIFF project, yet it took more than 4 years to roll-out previous guidelines. All PMTCT indicators increased significantly (p < 0.001) comparing the five-year periods before and during the EGPAF-CIFF project. Critical path activities implemented increased five of the seven PMTCT uptake indicators.
CONCLUSIONS: Zimbabwe rapidly rolled-out and optimised new WHO PMTCT guidelines and drastically reduced its MTCT rate using the critical path method. We recommend wider use of the critical path method in public health programmes.
METHODS: We analysed activities implemented and PMTCT programme data for the period before and during the EGPAF-CIFF project. The critical path method involved a cycle of collecting and analysing quarterly PMTCT indicator data and planning and implementing targeted activities to improve the PMTCT indicators. We performed a graphical trend analysis of data that measured availability of PMTCT services. Using Pearson\'s Chi2 test, we compared results of PMTCT uptake indicators at the start and end of the EGPAF-CIFF project and used regression discontinuity analysis to assess effectiveness of activities implemented to improve the PMTCT service uptake indicators.
RESULTS: Zimbabwe rolled out WHO 2010 and 2013 PMTCT guidelines in less than 1 year during the EGPAF-CIFF project, yet it took more than 4 years to roll-out previous guidelines. All PMTCT indicators increased significantly (p < 0.001) comparing the five-year periods before and during the EGPAF-CIFF project. Critical path activities implemented increased five of the seven PMTCT uptake indicators.
CONCLUSIONS: Zimbabwe rapidly rolled-out and optimised new WHO PMTCT guidelines and drastically reduced its MTCT rate using the critical path method. We recommend wider use of the critical path method in public health programmes.
摘要：
背景：在某些国家实现消除艾滋病毒母婴传播（MTCT）的目标，增加了在全世界儿童中结束艾滋病毒流行的希望。然而,在大多数撒哈拉以南非洲国家，MTCT率仍远高于5％的消除目标。这些国家需要创新战略来扩大其干预措施，以终止儿科艾滋病毒。我们描述了伊丽莎白·格拉泽儿科艾滋病基金会（EGPAF）联盟和儿童投资基金基金会（CIFF）如何使用关键路径方法来促进2010年和2013年WHOPMTCT指南的快速扩展和优化，以将津巴布韦的MTCT率从2010年的22％降低到2015年的6.4％。
方法：我们分析了EGPAF-CIFF项目之前和期间实施的活动和PMTCT计划数据。关键路径方法涉及收集和分析季度PMTCT指标数据以及计划和实施针对性活动以改善PMTCT指标的循环。我们对衡量PMTCT服务可用性的数据进行了图形趋势分析。使用Pearson的Chi2测试，我们比较了EGPAF-CIFF项目开始和结束时PMTCT接受指标的结果,并使用回归不连续分析来评估为改善PMTCT服务接受指标而开展的活动的有效性.
结果：津巴布韦在EGPAF-CIFF项目期间不到一年的时间内推出了世卫组织2010年和2013年预防母婴传播指南，然而，推出以前的指导方针花了4年多的时间。与EGPAF-CIFF项目之前和期间的五年期间相比，所有PMTCT指标均显着增加（p<0.001）。实施的关键路径活动增加了七个PMTCT吸收指标中的五个。
结论：津巴布韦迅速推出并优化了新的WHOPMTCT指南，并使用关键路径方法大大降低了其MTCT率。我们建议在公共卫生计划中更广泛地使用关键路径方法。
方法：我们分析了EGPAF-CIFF项目之前和期间实施的活动和PMTCT计划数据。关键路径方法涉及收集和分析季度PMTCT指标数据以及计划和实施针对性活动以改善PMTCT指标的循环。我们对衡量PMTCT服务可用性的数据进行了图形趋势分析。使用Pearson的Chi2测试，我们比较了EGPAF-CIFF项目开始和结束时PMTCT接受指标的结果,并使用回归不连续分析来评估为改善PMTCT服务接受指标而开展的活动的有效性.
结果：津巴布韦在EGPAF-CIFF项目期间不到一年的时间内推出了世卫组织2010年和2013年预防母婴传播指南，然而，推出以前的指导方针花了4年多的时间。与EGPAF-CIFF项目之前和期间的五年期间相比，所有PMTCT指标均显着增加（p<0.001）。实施的关键路径活动增加了七个PMTCT吸收指标中的五个。
结论：津巴布韦迅速推出并优化了新的WHOPMTCT指南，并使用关键路径方法大大降低了其MTCT率。我们建议在公共卫生计划中更广泛地使用关键路径方法。
