背景:在12周龄之前感染HIV的婴儿开始抗逆转录病毒治疗(ART)可以将死亡风险降低75%。即时护理(POC)诊断测试对于及时启动ART至关重要;但是,尽管它的可用性,在12周龄之前,ART起始率仍然相对较低。这项系统评价描述了12周龄前婴儿开始ART的障碍,尽管有POC。
方法:本系统综述使用叙述性综合方法。我们使用搜索策略搜索PubMed和Scopus,这些策略结合了关键词“婴儿早期开始接受抗逆转录病毒治疗”的多个变体,“障碍”和“撒哈拉以南非洲”(初始搜索2023年1月18日;最终搜索2023年8月1日)。我们包括定性,观察性和混合方法研究报告了婴儿早期开始对ART的影响。我们排除了报道对预防母婴传播级联的其他组成部分有影响的研究。使用以更新的实施研究综合框架为指导的演绎方法,我们围绕婴儿早期开始接受ART的障碍制定了描述性代码和主题。然后,我们使用该行动为已识别的障碍制定了干预建议,演员,代码中的目标和时间框架。
结果:在所审查的266篇摘要中,审查了52篇全文论文,其中包括12篇论文。南非的论文大多来自一个国家(n=3),报道最多的研究设计是回顾性的(n=6)。在0-12个月的婴儿中,超过12周的ART开始延迟主要与医疗机构和母亲因素有关。确定的最突出的障碍是POC测试资源不足(包括人力资源、实验室设施和患者随访)。产妇相关因素,如有限的男性参与和母亲对治疗和护理的看法,也有影响力。
结论:我们确定了卫生系统启动ART的结构性障碍,社会和文化层面。改进了POC测试作业的资源及时分配,加上解决母亲和医疗保健提供者之间社会和行为障碍的干预措施,承诺加强婴儿及时启动ART。
结论:本文确定了婴儿及时启动ART的障碍并提出了策略。
BACKGROUND: Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point-of-care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic
review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC.
METHODS: This systematic
review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords \"early infant initiation on antiretroviral therapy,\" \"barriers\" and \"sub-Saharan Africa\" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes.
RESULTS: Of the 266 abstracts reviewed, 52 full-text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0-12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow-up). Maternal-related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential.
CONCLUSIONS: We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants.
CONCLUSIONS: This paper identifies barriers and proposes strategies for timely ART initiation in infants.