# name
Implementation and Operational Research: An Integrated and
                Comprehensive Service Delivery Model to Improve Pediatric and
                Maternal HIV Care in Rural Africa

# metadata.dc.description.abstract[].value
BACKGROUND: Strategies to improve HIV diagnosis and linkage into
                care, antiretroviral treatment coverage, and treatment outcomes
                of mothers and children are urgently needed in sub-Saharan
                Africa. METHODS: From December 2012, we implemented an
                intervention package to improve prevention of mother-to-child
                transmission (PMTCT) and pediatric HIV care in our rural
                Tanzanian clinic, consisting of: (1) creation of a PMTCT and
                pediatric unit integrated within the reproductive and child
                health clinic; (2) implementation of electronic medical records;
                (3) provider-initiated HIV testing and counseling in the
                hospital wards; and (4) early infant diagnosis test performed
                locally. To assess the impact of this strategy, clinical
                characteristics and outcomes were compared between the period
                before (2008-2012) and during/after the implementation
                (2013-2014). RESULTS: After the intervention, the number of
                mothers and children enrolled into care almost doubled. Compared
                with the pre-intervention period (2008-2012), in 2013-2014,
                children presented lower CD4% (16 vs. 16.8, P = 0.08) and more
                advanced disease (World Health Organization stage 3/4 72% vs.
                35%, P < 0.001). The antiretroviral treatment coverage rose
                from 80% to 98% (P < 0.001), the lost-to-follow-up rate
                decreased from 20% to 11% (P = 0.002), and mortality
                ascertainment improved. During 2013-2014, 261 HIV-exposed
                infants were enrolled, and the early mother-to-child
                transmission rate among mother-infant pairs accessing PMTCT was
                2%. CONCLUSIONS: This strategy resulted in an increased number
                of mothers and children diagnosed and linked into care, a higher
                detection of children with AIDS, universal treatment coverage,
                lower loss to follow-up, and an early mother-to-child
                transmission rate below the threshold of elimination. This study
                documents a feasible and scalable model for family-centered HIV
                care in sub-Saharan Africa.

# metadata.dc.relation.ispartof[].value
Journal of Acquired Immune Deficiency Syndromes, 2016, vol. 73,
                num. 5, p. e67-e75

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Implementation and Operational Research: An Integrated and
                Comprehensive Service Delivery Model to Improve Pediatric and
                Maternal HIV Care in Rural Africa