Integrating gestational diabetes and type 2 diabetes care into primary health care: Lessons from prevention of mother-to-child transmission of HIV in South Africa - A mixed methods study.

Autor: Mutabazi JC; Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada.; Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada.; Centre de Recherche du Centre Hospitalier de l'Universitaire Sainte Justine, Montréal, QC, Canada., Enok Bonong PR; Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada.; Centre de Recherche du Centre Hospitalier de l'Universitaire Sainte Justine, Montréal, QC, Canada., Trottier H; Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada.; Centre de Recherche du Centre Hospitalier de l'Universitaire Sainte Justine, Montréal, QC, Canada., Ware LJ; SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa., Norris SA; SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa., Murphy K; Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western Cape, South Africa., Levitt N; Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western Cape, South Africa., Zarowsky C; Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada.; Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada.; School of Public Health, University of the Western Cape, Bellville, South Africa.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 Jan 22; Vol. 16 (1), pp. e0245229. Date of Electronic Publication: 2021 Jan 22 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0245229
Abstrakt: Background: Implementation of the programmes for the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) into antenatal care over the last three decades could inform implementation of interventions for other health challenges such as gestational diabetes mellitus (GDM). This study assessed PMTCT outcomes, and how GDM screening, care, and type 2 diabetes (T2DM) prevention were integrated into PMTCT in Western Cape (WC), South Africa.
Methods: A convergent mixed methods and triangulation design were used. Content and thematic analysis of PMTCT-related policy documents and of 30 semi-structured interviews with HIV/PMTCT experts, health care workers and women under PMTC diagnosed with GDM complement quantitative longitudinal analysis of PMTCT implementation indicators across the WC for 2012-2017.
Results: Provincial PMTCT and Post Natal Care (PNC) documents emphasized the importance of PMTCT, but GDM screening and T2DM prevention were not covered. Data on women with both HIV and GDM were not available and GDM screening was not integrated into PMTCT. Women who attended HIV counselling and testing annually increased at 17.8% (95% CI: 12.9% - 22.0%), while women who delivered under PMTCT increased at 3.1% (95% CI: 0.6% - 5.9%) annually in the WC. All 30 respondents favour integrating GDM screening and T2DM prevention initiatives into PMTCT.
Conclusion: PMTCT programmes have not yet integrated GDM care. However, Western Cape PMTCT integration experience suggests that antenatal GDM screening and post-partum initiatives for preventing or delaying T2DM can be successfully integrated into PMTCT and primary care.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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