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BMC Research Notes

, 7:177

Public Health

Abstract

BackgroundThe objectives of this paper are: 1 to study the feasibility and relative benefits of integrating the prevention of parent-to-child transmission PPTCT component of the National AIDS Control Program with the maternal and child health component of the National Rural Health Mission NRHM by offering HIV screening at the primary healthcare level; and 2 to estimate the incremental cost-effectiveness ratio to understand whether the costs are commensurate with the benefits.

MethodsThe intervention included advocacy with political, administrative-health heads, and capacity building of health staff in Satara district, Maharashtra, India. The intervention also conducted biannual outreach activities at primary health centers PHCs-sub-centers SCs; initiated facility-based integrated counseling and testing centers FICTCs at all round-the-clock PHCs; made the existing FICTCs functional and trained PHC nurses in HIV screening. All -functional- FICTCs were equipped to screen for HIV and trained staff provided counseling and conducted HIV testing as per the national protocol. Data were collected pre- and post- integration on the number of pregnant women screened for HIV, the number of functional FICTCs and intervention costs. Trend analyses on various outcome measures were conducted. Further, the incremental cost-effectiveness ratio per pregnant woman screened was calculated.

ResultsAn additional 27% of HIV-infected women were detected during the intervention period as the annual HIV screening increased from pre- to post-intervention 55% to 79%, p < 0.001 among antenatal care ANC attendees under the NRHM. A greater increase in HIV screening was observed in PHCs-SCs. The proportions of functional FICTCs increased from 47% to 97% p < 0.001. Additionally, 93% of HIV-infected pregnant women were linked to anti-retroviral therapy centers; 92% of mother-baby pairs received Nevirapine; and 89% of exposed babies were enrolled for early infant diagnosis. The incremental cost-effectiveness ratio was estimated at INR 44 less than 1 US$ per pregnant woman tested.

ConclusionsIntegrating HIV screening with the broader Rural Health Mission is a promising opportunity to scale up the PPTCT program. However, advocacy, sensitization, capacity building and the judicious utilization of available resources are key to widening the reach of the PPTCT program in India and elsewhere.

KeywordsIntegration Health programs HIV screening Antenatal care PPTCT Cost and cost-effectiveness Electronic supplementary materialThe online version of this article doi:10.1186-1756-0500-7-177 contains supplementary material, which is available to authorized users.

Suchitra V Bindoria, Ramesh Devkar, Indrani Gupta, Virupax Ranebennur, Niranjan Saggurti, Sowmya Ramesh, Dilip Deshmukh and Sanjeevsingh Gaikwad contributed equally to this work.

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Autor: Suchitra V Bindoria - Ramesh Devkar - Indrani Gupta - Virupax Ranebennur - Niranjan Saggurti - Sowmya Ramesh - Dilip Deshm

Fuente: https://link.springer.com/







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