2007～2009年昆明市艾滋病母婴传播干预效果分析

目的分析昆明市艾滋病病毒(HIV)阳性孕产妇母婴传播综合干预措施实施情况及其效果,为开展与推广HIV母婴阻断的预防工作提供参考。方法对2007～2009年昆明市第三人民医院收治的HIV阳性孕产妇的病历资料进行回顾性分析。结果 2007～2009年收治的临产前检出145例HIV阳性孕产妇中,100%接受了母婴传播干预服务,其中35.17%选择终止妊娠,64.83%选择继续妊娠,100%接受了婴幼儿喂养指导。23例HIV感染孕产妇所生婴幼儿接受了随访,其中11例婴儿HIV抗体为阴性,另12例在继续接受随访。结论昆明市HIV感染孕产妇母婴传播的综合干预措施是有效的,HIV传播阻断综合干预措施是降低HIV母婴传播的关键,值得大力推广实施。     

师宗县2006-2010年实施预防艾滋病母婴阻断措施初见成效

目的：通过分析5年来实施预防艾滋病母婴传播工作情况,总结工作经验,以促进今后工作中更加规范各项预防措施,切实降低当地艾滋病母婴传播机率。方法：查阅2006-2010年师宗县预防艾滋病母要传播工作报表、HIV感染孕产妇个案卡及所生儿童随访卡,分析该措施取得的效果。结果：通过5年来实施预防艾滋病母婴阻断措施,对减少通过母婴传播途径感染艾滋病起到了良好作用。结论：通过规范开展预防艾滋病母婴阻断措施,能有效避免HIV感染孕产妇所生婴儿发生垂直传播。     

人类免疫缺陷病毒阳性孕妇终止妊娠情况及影响因素

母婴传播是儿童感染人类免疫缺陷病毒( human immunodeficiency virus,HIV)的主要途径[1 3]。我国公布的《艾滋病防治条例》规定HIV阳性妇女有婚姻和生育自由,并提供免费抗反转录病毒( antiretroviral,ARV)药物以阻断母婴传播。尽管采取综合阻断措施（ARV药物、产科干预、人工喂养）后HIV的母婴传播率明显降低,但仍存在母婴传播的危险,故国内外均有部分HIV阳性孕妇自愿选择终止妊娠。为了解我国不同地区的HIV阳性孕妇自愿选择终止妊娠的情况,改进HIV母婴阻断工作,开展了本研究,现将结果报告如下。     

免疫阻断乙型肝炎病毒母婴传播多中心研究

目的 探讨孕产妇乙型肝炎表面抗原（HBsAg）阳性率及乙型肝炎病毒（HBV）母婴传播阻断的效果。方法 2008－2012年,通过多中心队列研究,对湖北省、山西省、广东省、新疆维吾尔自治区等地的孕产妇进行HBsAg筛查;对上述地区部分医院入院分娩的HBsAg阳性母亲及8～12个月龄婴儿进行随访观察,所有标本检测乙型肝炎血清标志物(HBsAg,HBsAb,HBeAg,HBeAb,HBcAb),部分标本检测HBV DNA。结果　筛查孕妇82214例,HBsAg阳性4924例,阳性率6.0%。随访HBsAg阳性母亲及8～12个月龄婴儿1371对,婴儿免疫阻断失败率3.1%（42/1371）,HBsAg及HBeAg双阳性母亲婴儿的免疫阻断失败率为8.2%。免疫阻断失败的婴儿其母亲均为HBeAg阳性且HBV DNA≥6 log10 copies/mL。HBeAg阳性母亲孕期注射乙型肝炎免疫球蛋白(hepatitis B immune globulin, HBIG)及未注射HBIG组,其婴儿免疫阻断失败率差异无统计学意义(8.8% vs. 8.1%, P=0.807)。结论　多中心调查显示目前孕产妇HBsAg阳性率6.0%,HBV母婴阻断失败率3.1%。HBsAg及HBeAg双阳性且HBV DNA≥6 log10 copies/mL 的孕妇应为母婴阻断的重点人群。孕妇孕期注射HBIG不能提高HBV母婴阻断效果。     

艾滋病母婴传播的预防与干预

国际社会对于预防艾滋病母婴传播已经明确提出了4个步骤,即首先预防育龄妇女感染;防止已感染妇女非意愿的妊娠;预防通过孕期、分娩期和产后阶段的母婴垂直传播;对感染孕产妇及其家庭提供综合关爱。对于预防艾滋病母婴传播的干预,倡导提供综合的干预措施,以达到最大限度地降低艾滋病母婴传播率,对孕产妇及其家庭的伤害降低到最小程度的目的。1艾滋病母婴传播的预防1·1预防育龄妇女HIV感染目前艾滋病的流行趋势已显示出从高危人群向一般人群扩散、男性感染为主转向女性的感染率不断增高的特点,使得艾滋病母婴传播的危险性更加增大,严重威胁…     

孕前或孕期感染人类免疫缺陷病毒后的母婴传播

目的 了解我国妇女孕前或孕期感染人类免疫缺陷病毒( human immunodeficiency virus,HIV)所致的母婴传播情况及其影响因素. 方法 选取2000年1月至2009年12月我国中部地区部分县市及新疆伊宁市277例孕前或孕期感染HIV的女性及其分娩的322例子代为研究对象,分析HIV亚型及母婴传播率.采用x2检验及Logistic回归分析探讨相关影响因素.结果 277例孕前或孕期感染HIV的女性中,199例为血液途径感染,其中174例HIV亚型检测成功,均为B'亚型,而通过性传播途径感染的78例女性中,58例HIV亚型检测成功,以重组型CRF01-BC和CRF-AE为主,分别为35例(60.3％)和20例(34.5％),仅3例(5.2％)为B’型.322例子代中接受HIV检测前死亡12例,余310例接受HIV检测的子代中108例为阳性,HIV母婴传播率为34.8％ (95％ CI:29.5％～40.1％);单因素分析显示,人工喂养者的子代HIV阳性率低于母乳喂养者[12.5％(6/48)与38.9％(102/262),x2=12.484,P=0.000];母亲感染HIV的年限＜7年者的母婴传播率低于感染年限≥7年者[28.8％(46/160)与54.2％(32/59),x2=12.211,P=0.000].多因素Logistic回归分析提示女性感染HIV年限(OR=1.342,95％CI:1.189～1.515,P=0.000)和母乳喂养持续时间(OR=1.137,95％CI:1.053～1.227,P=0.001)是HIV母婴传播的危险因素.结论 女性HIV感染后HIV亚型与其传播途径有关.人工喂养可以降低HIV母婴传播率,女性HIV感染年限长、母乳喂养持续时间久可增加HIV母婴传播率.     

妊娠合并人类免疫缺陷病毒感染

人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染孕产妇人数及分娩需求逐年增加,产科临床医师应对HIV母婴传播机制及影响因素、实验室检查、诊断方法,孕期保健,产时、产后及新生儿处理等方面的新进展以及注意事项应有所认识和了解,以推动HIV母婴阻断措施的实施。     

2076例HIV感染孕产妇流行病学特征分析

目的:调查我国15省85县(市、区)HIV感染孕产妇的基本人口学特征和感染途径。方法:对我国15省85县(市、区)2004~2008年检测发现并确认感染的2076例HIV感染孕产妇进行问卷调查和登记。结果:(1)HIV感染孕产妇的平均年龄28.58±5.87岁,66.4%为汉族,91.4%为农民或无业,58.6%为小学及以下文化程度,初婚占76.1%;(2)53.3%的HIV感染孕产妇通过异性性行为感染,24.7%通过采血(浆)感染,通过输血、使用血制品感染占3.8%,通过注射吸毒感染占3.4%;(3)性传播比例逐年增加,由2004年的21.9%增加到2008年的67.7%(χ2M-H=130.56,P0.01)。结论:绝大多数感染HIV孕产妇的文化水平较低,在家务农或者无业者比例较大。性传播是孕产妇HIV感染的主要途径,并逐年增加。应针对感染人群不同的流行病学特征,采取有针对性的艾滋病综合防治措施与策略,特别要遏制性传播途径比例的进一步增加。     

抗病毒药物预防艾滋病母婴传播

我国艾滋病流行已从高危人群向普通人群蔓延,截止2005年底女性累计感染者已占到感染总数的27·6%。对于母婴传播(mother to children transmission,MTCT),不同国家传播率不大相同,HIV阳性孕产妇不采取任何干预措施约,15%~50%会发生母婴传播(在欧美地区为15%~20%)[1]。在发达国家,由于进行抗逆转录病毒药物治疗(anti-retroviral therapy,ART),已使HIV母婴传播率降到8%以下[2]。近年来对HIV阳性母亲在围生期综合应用抗逆转录病毒药物、选择性剖宫产和人工喂养等措施,使HIV的母婴传播率下降到2%以下。抗逆转录病毒药物的使用,起到了至…     

人类免疫缺陷病毒感染孕期筛查及母婴垂直传播的预防

人类免疫缺陷病毒(HIV)的母婴垂直传播是儿童感染HIV的主要原因。母婴垂直传播可发生于3个关键时期:孕期、产时及产后哺乳过程。孕期筛查出HIV阳性孕妇,并采取综合阻断措施——抗逆转录病毒药物应用、选择性剖宫产和人工喂养等,对于有效降低HIV母婴垂直传播具有重要意义。     

Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-sectional survey

Background  

Mother-to-child transmission of HIV (MTCT) accounts for over 95% of all paediatric HIV infections worldwide. Several studies have shown that male participation in the antenatal care of their spouses together with couple counselling and testing for HIV, increases use of the interventions for HIV prevention. The prevention programme of MTCT (PMTCT) was launched in Uganda in 2000 and Mbale in 2002. Less than 10% of the pregnant women accepted antenatal HIV testing at Mbale Regional Referral Hospital in 2003; couple counselling and testing for HIV was low. Therefore, we conducted the study to determine the level of male involvement and identify its determinants in the PMTCT programme.     

The HIV infection in pregnant women in French Guiana

OBJECTIVE: The aim of this study is to analyse the characteristics of HIV pregnant women in French Guiana then to evaluate the HIV mother to child transmission rate (MTCT) and determine the pronostic factors associated with MTCT. PATIENTS AND METHOD: An epidemiological study has been led including all deliveries in French Guiana from January 1998 to December 2000. For each case a standardized questionnaire has been gathered including epidemiological, clinical and biological data and an univariate analysis has been realized. A hundred and forty-eight women have been included in the study among 135 women came for delivery. RESULTS: The factors associated with increased MTCT in our study were no antiretroviral therapy before delivery, the lack of follow-up during pregnancy and no antiretroviral therapy in children. The HIV mother to child transmission rate was 6,5% despite the availability of antiretroviral therapies. DISCUSSION AND CONCLUSION: This rate may be explained by the difficulties of follow-up in HIV infected women. Much more needs to be done to improve access to care for women coming from foreign countries. This may be indispensable to reduce the HIV mother to child transmission rate in French Guiana.     

Determinant factors of pregnant mothers' knowledge on mother to child transmission of HIV and its prevention in Gondar town, North West Ethiopia

ABSTRACT: BACKGROUND: Mother-to-child transmission of HIV also is a very important mode of HIV transmission for children. Well-functioning and accessible health facility and knowledge on mother to child transmission of HIV are a prerequisite for a successful mother to child transmission prevention of HIV. However, the determinant factors of pregnant mothers' knowledge towards mother to child transmission of HIV and its prevention is not well studied in Ethiopia and particularly in the present study area. METHODS: Cross-sectional health institution based study was conducted in Gondar town from July 22-August 18, 2011. A total of 400 pregnant women attending antenatal care (ANC) were involved in the study using stratified sampling technique. Data were collected by using structured questionnaire and multiple logistic regression analysis was used. RESULTS: A total of 400 pregnant women actively participated in this study and 354 (88.5%) of them knew mother to child transmission of HIV and 334(83.5%) of them knew mother to child transmission of HIV is preventable. Having knowledge on mother to child transmission of HIV was positively associated with attending antenatal care visits in hospitals [Adj. OR (95%CI) = 4.49 (1.003, 20.06)], residing in urban areas [Adj. OR (95%CI) = 2.46 (1.19, 5.09)] and having education level of secondary and above [Adj. OR (95%CI) = 6.85 (1.96, 24.01)], but negatively associated with increased maternal age. Knowledge on prevention of mother to child transmission of HIV was positively associated with accessibility of health facility [Adj. OR (95%CI) = 2.16 (1.03, 4.57)], having perceived risk of HIV [Adj. OR (95%CI) = 2.61 (1.32, 5.17)], having comprehensive knowledge on HIV [Adj. OR (95%CI) = 2.86 (1.41, 5.82)], having education level of secondary and above [Adj. OR (95%CI) = 6.15 (1.75, 21.66)] and residing in urban areas [Adj. OR (95%CI) = 3.62 (1.73, 7.59)] but negatively associated with increased maternal age. CONCLUSION: Most of the study participants in this study knew that HIV could be transmitted from an infected mother to her baby. There should be well functioning and accessible health facilities with Prevention of mother to child transmission service in the country especially in the rural areas.     

Human immunodeficiency virus in pregnancy

Most human immunodeficiency virus (HIV) infection in women of childbearing age occurs in resource poor countries. However, increasing numbers of infected women are known to reside in the UK. In developed countries, with appropriate healthcare, HIV infection in adults may be regarded as a chronic manageable condition and mother-to-child transmission (MTCT) can be almost totally prevented.Despite great improvements in antenatal testing in the UK, the greatest single contributor to MTCT is failure to diagnose HIV in pregnancy. Once diagnosed, HIV in pregnancy is best managed by a specialist multidisciplinary team, who can maximise the mother’s health and reduce the risk of MTCT to less than 1%.The British HIV Association has recently published its 2008 guidelines for the management of HIV in pregnancy. Avoidance of breastfeeding and appropriate use of antiretrovirals with or without pre-labour Caesarean section remain the main interventions minimising the risk of MTCT.     

An Ethical Analysis of Opt-Out HIV Screening for Pregnant Women

Critical advances in prevention of mother-to-child-transmission (MTCT) of the HIV in the perinatal period have changed practice recommendations for HIV screening for pregnant women. Using case studies we illustrate the ethical complexities and implications of opt-out HIV testing for pregnant women. Despite the potential for compromised informed consent, an opt-out HIV screening approach is ethically defensible.     

Evaluation of an Emergency Prevention Program for Mother to Child Transmission of HIV in British Columbia

IntroductionThe objective of this study was to evaluate a provincewide program designed to identify HIV infection accurately and to prevent mother to child transmission among high-risk pregnant women of unknown serostatus.MethodsBetween 2000 and 2007, 347 high-risk women were identified through the Prevention of Mother to Child Transmission (PMTCT) program implemented in 27 hospitals across British Columbia. Rates of HIV transmission and details of the implementation of prophylaxis kits were assessed.ResultsOf the 346 high-risk mother-infant pairs identified and included in the provincial program, 35.4% of the mothers and 95.7% of infants received antiretroviral therapy for prevention of vertical transmission. Of 309 pairs who subsequently underwent HIV testing, five mothers were found to be HIV positive, an infection rate of 16.2/1000 in this cohort; the overall rate in BC is 0.68/1000 births. One of the five infants born to an HIV positive mother was infected with HIV.DiscussionThe program was successful in identifying a subgroup of pregnant women at increased risk of HIV infection; however, mother to child transmission occurred in one of five cases (20%). To reduce the risk of mother to child HIV transmission in BC to the lowest possible level, additional strategies such as increasing uptake of prenatal screening and point-of-care testing in labour and delivery may need to be explored.     

Rapid HIV testing and counselling in labour in a northern Nigerian setting

Between April and August 2004, all pregnant women in labour at JUTH, were offered rapid HIV testing and counselling with opportunity to decline testing. HIV positive women were offered the standard nevirapine mono-therapy prophylaxis regimen (HIVNET 012). Four hundred and thirty (99.8%) of the 431 pregnant women who were offered rapid HIV testing and counselling, agreed to test. A sero-conversion rate of 2.1% (5 of 235) was found among women who had previously tested negative for HIV during the index pregnancy. A seroprevalence rate of 9.6% (16 of 166) was found among women with unknown HIV status. One patient who had an indeterminate HIV status prior to labour tested positive in labour. Rapid HIV testing and counselling in labour is a useful practice in high prevalence settings since it detects a substantial number of HIV-infected women and HIV-exposed babies that would otherwise have missed interventions to prevent MTCT.     

Are public antenatal clinics in Blantyre, Malawi, ready to offer services for the prevention of vertical transmission of HIV?

At least 100% of the adult population in Malawi is infected with HIV and vertical transmission is a major mode of transmission. Currently, there are plans to provide widespread antiretroviral therapy to prevent mother to child transmission of HIV. This study was conducted to describe the perceptions of midwives towards selected issues regarding prevention of mother to child transmission of HIV in eleven public health centres in Blantyre, Malawi. A cross-sectional study using a self-administered questionnaire incorporating both open-ended and closed-ended questions was used. Twenty seven midwives participated in the study. Less than half (40.7%), of them reported working at a baby friendly hospital initiative health facility, while 96.3% reported that they would advise an HIV infected woman to breastfeed her infant. HIV prevention messages were reportedly offered routinely by 77.8% of the respondents, but only 22.2% reported that their clinics offered condoms to pregnant women. Also, only 37.0% reported offering routine STI screening, while 37.0% of the midwives would support antenatal women being accompanied by their male partners Majority (81.2%) said that women who know they are HIV infected should not become pregnant, while 37.0% reported that they would be uncomfortable to assist in the delivery of an HIV infected woman. There was lack of appropriate clinic space and sterile gloves for the proper delivery of maternity services. Midwives in Malawi need training, supervision and other support to provide adequate health care services to antenatal women.