艾滋病母婴阻断抗病毒治疗依从性及相关因素分析

目的 探索艾滋病母婴传播阻断抗病毒治疗依从性的主要影响因素,为制定提高人类免疫缺陷病毒阳性孕产妇抗病毒治疗依从性的措施提供依据.方法 在云南省5个艾滋病高、中度流行县(市、区),对艾滋病母婴传播阻断抗病毒治疗方案的依从性进行了病例对照研究和定性调查.结果 抗病毒治疗依从性良好者占86.7%(137/158).影响人类免疫缺陷病毒阳性孕妇及婴儿服药依从性的主要因素为产次、民族、是否知情选择方案、方案复杂程度、对阻断成功的信心.结论 云南省人类免疫缺陷病毒感染孕产妇艾滋病母婴传播阻断抗病毒治疗依从性好,依从性受多种因素的影响,提高依从性要针对主要影响因素开展工作. 素,为制定提高人类免疫缺陷病毒阳性孕产妇抗病毒治疗依从性的措施提供依据.方法 在云南省5个艾滋病高、中度流行县(市、区),对艾滋病母婴传播阻断抗病毒治疗方案的依从性进行了病例对照研究和定性调查.结果 抗病毒治疗依从性良好者占86.7%(137/158).影响人类免疫缺陷病毒阳性孕妇及耍儿服药依从性的主要因素为产次、民族、是否知情选择方案、方案复杂程度、对阻断成功的信心.结论 云南省人类免疫缺陷病毒感染孕产妇艾滋病母婴传播阻断抗病毒治疗依从性好,依从性受 种因素的影响,提高依从性要针对主要影响因素开展     

艾滋病母婴传播阻断抗病毒治疗规范用药影响因素现况研究

目的 了解艾滋病母婴传播阻断抗病毒治疗的规范用药水平,探索其影响因素,为制定规范用药的措施提供依据.方法 采用现况调查方法在云南省5个艾滋病高、中流行县(市、区)对2005年1月至2007年6月接受母婴传播阻断服务的167例孕产妇及57名提供服务的医务人员进行调查,对艾滋病母婴传播阻断抗病毒治疗方案的选择与应用是否合理及艾滋病病毒(HIV)感染孕产妇依从性的主要影响因素进行定性和定量调查.结果 接受母婴传播阻断服务的167例HIV感染产妇中,抗病毒治疗规范用药率为65.87%(110/167);其中方案选择合理率为88.02%(147/167),产时用药合理率81.37%(131/161),依从率为87.42%(146/167).艾滋病母婴传播阻断抗病毒治疗规范用药的主要影响因素为确诊时间(OR=2.617;95%CI: 1.184～5.783),是否在阻断定点机构分娩(OR=0.064;95%CI:0.007～0.607),民族(OR=0.344;95%CI:0.162～0.730),是否知道服药阻断的目的 (OR=6.843;95%CI:1.449～32.312),以及医生对抗病毒治疗的认识不够,5个关键知识点(母婴阻断目的 、不按要求服药后果、各方案疗效、CD4高低与选择方案的关系、有关药物可能出现的副作用)的正确认识率为47.72%(136/285).结论 艾滋病母婴传播阻断抗病毒治疗规范用药的总体水平不高,受医患双方及社会等多种因素影响,有必要针对主要影响因素制定规范用药的措施.     

我国HIV感染孕产妇应用抗病毒药物情况及依从性研究进展

艾滋病严重危害人类健康,其中妇女和儿童也遭受艾滋病不同程度的伤害,艾滋病母婴阻断措施是降低母婴传播的有效手段,而艾滋病感染孕产妇应用抗病毒药物依从性则是影响母婴阻断干预效果的关键因素之一。本文从分析我国感染HIV孕产妇应用抗病毒药物情况入手,进一步探讨HIV感染孕产妇用药依从性的影响因素。     

尉氏县阻断HIV母婴传播效果观察

目的根据2003～2008年尉氏县孕产妇及所生儿童HIV感染情况,评价预防艾滋病母婴传播的效果,为今后更好地采取母婴阻断措施提供参考依据。方法回顾性分析尉氏县疾病预防控制中心和尉氏县提供助产服务的所有医疗保健机构2003～2008年HIV感染孕产妇及所生儿童服用抗逆转录病毒药物情况及随访检测记录,分析预防艾滋病母婴传播效果。结果 5年来共发现阳性孕产妇230人,终止妊娠86人,实施母婴药物阻断措施141人,出生婴幼儿142人,均采取抗病毒服药、安全助产和喂养指导等母婴阻断措施。满18个月龄幼儿104人,其中满18个月龄HIV抗体阳性4人,阻断率96.15%。结论 5年来尉氏县孕产妇HIV抗体检测平均阳性率0.41%,与全国艾滋病高发地区感染率一致。预防艾滋病母婴传播措施可行,效果明显。需要认真研究如何提高孕前和孕期抗病毒服药率。     

促进艾滋病母婴阻断成功的综合干预措施及效果分析

目的 探讨开远市通过预防艾滋病母婴传播综合干预措施的实施,预防艾滋病母婴传播工作取得的成效.方法 对2003～2009期间,开远市育龄妇女及其家庭、孕产妇及其家庭、HIV阳性孕产妇及所生儿童等人群,通过实施预防艾滋病母婴传播(PMTCT)综合干预措施后,对其效果进行研究分析.结果 开远市育龄妇女及其家庭、孕产妇及家庭艾滋病知识知晓率为99％;孕产妇艾滋病自愿咨询率为96.99％、HIV抗体检测率为95.16％;孕产妇孕期筛查比例为95.06％;孕产妇HIV阳性检出率为0.64％;孕期HIV抗体阳性检出率为0.6％、产时阳性检出率为1.45％;孕期检出阳性所占比例为88.89％;HIV阳性孕产妇终止妊娠为40.14％、分娩为59.86％;HIV阳性孕产妇住院分娩率为100％;阳性孕产妇本人或所生婴幼儿采取至少1项主要干预措施的比例为93.18％; HIV阳性孕产妇服药率为78.41％;婴儿服药率为90％;婴儿人工喂养率为93.33％; 18月龄儿童HIV抗体检测率为91.67％,检测结果100％阴性,排除HIV感染.结论 开远市7年来通过综合干预措施的实施,预防艾滋病母婴传播阻断工作取得了显著成效.     

舟山市艾滋病母婴传播阻断综合干预效果评价

目的评价舟山市艾滋病母婴传播阻断综合干预效果,为开展艾滋病母婴传播阻断提供依据。方法对2013—2015年舟山市已经实施艾滋病母婴传播阻断的23例HIV阳性孕产妇资料进行回顾性分析。结果经艾滋病母婴传播阻断综合干预后,23例孕产妇中有8例(34.78%)在知情同意后选择终止妊娠,15例(65.22%)选择继续妊娠,并均接受孕期预防性抗病毒阻断用药,用药率为100.00%(15/15);15例妊娠妇女共活产婴儿17人,婴儿预防性抗病毒用药率为76.47%(13/17),婴儿人工喂养率为88.24%(15/17);婴儿18月龄时均未检出HIV感染。结论艾滋病母婴传播阻断综合干预措施能有效降低HIV母婴传播风险。     

昆明经开区艾滋病孕妇母婴阻断10例临床分析

目的分析昆明市经开区艾滋病病毒(HIV)阳性孕产妇感染现状及相关危险因素,分析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2009——2012年昆明市经开区随访的10例HIV阳性孕产妇的病历资料进行回顾性分析,逐一进行个案调查。结果 10例HIV阳性孕产妇中,100%接受了母婴传播干预服务,其中10%选择终止妊娠,90%选择继续妊娠,100%接受了婴幼儿喂养指导,100%HIV感染孕产妇所生婴幼儿接受了随访,其中2例婴儿HIV抗体为阴性,另7例在继续接受随访。结论应在医疗机构广泛开展PITC服务,提高婚前HIV检测率和孕期HIV检测率,提高VCT咨询质量,从而提高抗病毒药物应用的依从性及随访率,HIV传播阻断综合干预措施是降低HIV母婴传播的关键,是可减少、阻断HIV母婴垂直传播的。     

龙陵县预防艾滋病母婴传播现状分析

目的：分析笔者所在县母婴阻断工作的结果及现状,探索母婴阻断工作方法,降低艾滋病母婴传播发生率.方法：对2005-2009年进行HIV 抗体检测的17613 例孕产妇中的72 例阳性感染者和53 例阳性母亲所生婴儿母婴阻断情况进行分析.结果：孕产妇HIV 抗体阳性率为0.41%,经采取干预措施,所生婴儿HIV 感染率为零.结论：艾滋病母婴阻断是预防婴儿感染艾滋病的主要手段,采取预防艾滋病母婴传播综合干预措施,能有效降低母婴传播发生率.     

河南省实施HIV母婴传播干预措施效果分析

目的 了解实施艾滋病母婴传播干预措施对人类免疫缺陷病毒(HIV)母婴传播的影响。方法 对河南省31个重点县HIV阳性孕产妇及所生婴幼儿干预状况进行调查。调查新生儿出生时服药情况、喂养方式及其母亲的分娩方式、服用抗病毒药物等情况,比较服药组与未服药组幼儿人类免疫缺陷病毒(HIV)阳性率的差异。结果 实施药物阻断组艾滋病母婴传播率为3.45%,未实施药物阻断组的母婴传播率为15.38%,2组间差异有统计学意义,P<0.01。阳性产妇实施药物阻断措施后,自然分娩方式HIV传播率明显低于剖宫产方式的传播率。结论 对阳性孕产妇新生儿及时服用抗病毒药物并对婴儿实施纯人工喂养等措施,可有效降低HIV母婴传播率。建议在实施母婴传播干预措施的地区,不主张将HIV抗体阳性作为剖宫产的指征,最好选择自然分娩方式。     

楚雄市2006年～2010年艾滋病母婴阻断效果分析

[目的]了解楚雄市HIV感染孕产妇流行情况及预防HIV母婴传播综合干预效果。[方法]对楚雄市2006年～2010年到辖区各医疗保健机构首诊孕产妇进行HIV筛查,对HIV感染孕产妇进行咨询、采取母婴阻断措施并跟踪随访,对母婴阻断效果进行监测分析。[结果]楚雄市孕产妇HIV阳性率呈现平稳态势,感染率0.14%左右,处于中度流行地区;孕产妇感染HIV主要传播途径是性传播;目前使用的抗病毒药物对孕妇、胎儿及婴儿均安全、有效;感染孕产妇接受综合干预措施后,母婴阻断成功率为100%。[结论]实施预防艾滋病母婴传播措施,如孕早期检测、预防用药、人工喂养等,可有效降低艾滋病母婴传播率。     

联合抗病毒阻断AIDS母婴传播影响因素分析

目的 探索艾滋病母婴传播阻断抗逆转录病毒治疗联合方案应用的影响因素,为制定促进人类免疫缺陷病毒(HIV)阳性孕妇及其所生婴儿抗病毒治疗联合用药的措施提供依据。方法 在云南省5个艾滋病高、中度流行县(市、区),对艾滋病母婴传播阻断中选择抗病毒治疗联合方案的影响因素进行了定量和定性调查。结果 抗逆转录病毒治疗联合方案应用率为53.2%(84/158)。主要影响因素是为了子女不被感染、不让抽血的风俗习惯、交通、经济、服药怕人知道、首次咨询孕周、医生的用药倾向、知道方案数目、身体健康状况、费用承受能力、知道有副作用、阻断成功的信心。结论 抗逆转录病毒治疗联台方案的应用受多种因素影响。推广联合用药方案时要针对主要影响因素开展工作。     

湖南省2010-2013年预防艾滋病母婴传播情况分析

目的了解湖南省2010-2013年预防艾滋病母婴传播工作的开展情况,发现项目开展过程存在的问题和困难,为下一步项目工作的开展提供科学依据。方法从预防艾滋病母婴传播管理系统中收集2010-2013年全省住院分娩产妇的HIV检测情况、阳性孕产妇和所生婴儿的相关情况进行统计分析。结果2010-2013年湖南省住院分娩产妇的HIV抗体总检测率为88.37%,由2010年的69.53%上升到2013年的98.36%,差异有统计学意义（p=0.00）,发现525例阳性孕产妇,孕产妇感染率为1.84/万。阳性孕产妇的用药率为47.37%,接受了转介服务孕产妇为20.57%。分娩活产婴儿347例,其中进行人工喂养的为93.66%,婴儿进行抗病毒用药率为63.69%,阳性孕产妇所生婴儿早期诊断阳性率为6.54%。结论湖南省预防艾滋病母婴传播干预措施落实情况逐年提高,艾滋病母婴传播水平显著下降,孕产妇的用药率及相关转介服务,儿童的随访管理工作质量仍为工作中的薄弱环节。     

Universal combination antiretroviral regimens to prevent mother-to-child transmission of HIV in rural Zambia: a two-round cross-sectional study

Objective

To evaluate if a pilot programme to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) was associated with changes in early childhood survival at the population level in rural Zambia.

Methods

Combination antiretroviral regimens were offered to pregnant and breastfeeding, HIV-infected women, irrespective of immunological status, at four rural health facilities. Twenty-four-month HIV-free survival among children born to HIV-infected mothers was determined before and after PMTCT programme implementation using community surveys. Households were randomly selected and women who had given birth in the previous 24 months were asked to participate. Mothers were tested for HIV antibodies and children born to HIV-infected mothers were tested for viral deoxyribonucleic acid. Multivariable models were used to determine factors associated with child HIV infection or death.

Findings

In the first survey (2008–2009), 335 of 1778 women (18.8%) tested positive for HIV. In the second (2011), 390 of 2386 (16.3%) tested positive. The 24-month HIV-free survival in HIV-exposed children was 0.66 (95% confidence interval, CI: 0.63–0.76) in the first survey and 0.89 (95% CI: 0.83–0.94) in the second. Combination antiretroviral regimen use was associated with a lower risk of HIV infection or death in children (adjusted hazard ratio: 0.33, 95% CI: 0.15–0.73). Maternal knowledge of HIV status, use of HIV tests and use of combination regimens during pregnancy increased between the surveys.

Conclusion

The PMTCT programme was associated with an increased HIV-free survival in children born to HIV-infected mothers. Maternal utilization of HIV testing and treatment in the community also increased.     

Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda

BACKGROUND: To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda. METHODS: Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach. RESULTS: The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families. CONCLUSION: Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the 'opt-out' approach to HIV testing required further evaluation.     

驻马店市2001-2009年预防艾滋病母婴传播干预工作分析

目的 分析驻马店市开展预防艾滋病母婴传播干预工作以来,孕产妇人群中艾滋病病毒(HIV)感染情况和母婴传播情况及工作成效.方法 2001年10月-2009年5月,在全市孕产妇人群开展HIV自愿咨询与检测,共检测339 866名孕产妇;对检测过程中发现的594例HIV抗体阳性孕产妇进行综合干预,对其分娩的326名婴儿实施干预措施并在满12个月和18个月进行HIV抗体检测.结果 检测发现594例HIV阳性孕产妇,阳性率为0.17%(594/339 866),孕产妇HIV抗体检测阳性率呈现逐年下降趋势,最高年份2002年为0.47%(37/7837),最低年份2008年为0.12%(86/73 343).594例阳性孕产妇中,自愿终止妊娠228例,占38.38%(228/594);继续妊娠的43例,占7.24%(43/594);产妇317例,占53.37%(317/594).317例阳性产妇共生产婴儿326名,实施母婴阻断298名,实施阻断措施比率为94.01%(298/317);326名婴儿中存活317名,其中满18个月者224名,接受检测221名,检测出HIV阳性7例,接受干预措施后的母婴传播率为3.17%(7/221).结论 通过开展预防艾滋病母婴传播干预工作,可及时掌握孕产妇人群中HIV的感染状况,能有效降低艾滋病母婴传播水平.     

四川省凉山州布拖县HIV抗体阳性孕产妇母婴阻断措施实施情况分析

目的分析四川省凉山州布拖县预防艾滋病母婴传播措施的实施情况及母婴阻断效果。方法对2008年1月～2010年6月发现的177例HIV抗体阳性孕产妇的资料进行回归性分析,对其孕期服用抗病毒药物情况、妊娠结局、分娩方式、婴儿喂养方式、婴儿HIV感染情况等进行分析。结果 177例患者中,最终失访的有25例。剩余的152例中,终止妊娠的有5.9%(9/152),118例已分娩。还有25例处于妊娠期。分娩的产妇中有64.4%(76/118)服用过抗病毒药物,97.5%(115/118)为阴道分娩。已分娩的118例中,8例为死胎、死产,17例婴儿因各种原因死亡。存活的93例婴儿中,75.3%(70/93)服用了抗病毒药物,84.9%(79/93)采用人工喂养。8例婴儿在满18月龄时检测了HIV抗体,其中1例为阳性,其余为阴性。阻断率为87.5%(7/8)。结论布拖县对HIV阳性孕产妇所实施的综合干预措施对降低艾滋病母婴传播起到了良好作用,但仍需进一步加强。     

孕产妇艾滋病感染状况及母婴阻断的干预效果研究

目的为了解丽水市孕产妇HIV感染状况及母婴阻断的干预效果,指导艾滋病母婴阻断工作。方法对孕产妇进行HIV抗体检测,抗-HIV初筛阳性标本经艾滋病确认试验。结果 2006年10月1日—2010年9月30日4年间,孕产妇HIV感染率为2.29/万。孕期检出的HIV感染孕妇,更能配合母婴传播阻断措施的落实。目前存活的12名儿童有7名已满18个月,其中有6名抗-HIV抗体阴性,1名拒绝检测。结论丽水市孕产妇HIV感染处于较低水平。今后应加强艾滋病母婴阻断相关知识宣传,并将预防母婴传播服务与婚前、孕前、孕期保健有机结合,提高孕前和孕期HIV的检测率和HIV感染孕妇孕早期检出率。     

Determinants of HIV mother-to-child transmission in Catalonia,Spain [1997-2001]: is it possible to eliminate it?

OBJECTIVES: To identify and describe the factors that have led to new cases of HIV infection through mother-to-child transmission since the introduction of antiretroviral therapy in HIV-seropositive pregnant women (1997-2001) in Catalonia. METHODS: Systematic review of cases identified in the pediatric services of all the hospitals in Catalonia. RESULTS: Twenty-eight cases of pediatric HIV infection were identified: 9, 9, 8, 2 and 0 per year of birth from 1997 to 2001, respectively. Of 16 mothers with a diagnosis of known HIV infection before or during pregnancy, nine underwent antiretroviral prophylaxis during pregnancy (compliance was good in five, unknown in one and poor in one) and seven did not undergo prophylaxis (six refused it and no information was available in one). Of 12 mothers diagnosed after delivery, pregnancy was not monitored in five and was little or well-monitored in the remaining seven. Of mothers with well-monitored pregnancy, a serological HIV test was not performed in six and was negative in the first trimester in one. CONCLUSIONS: Mother-to-child transmission of HIV has decreased in the last few years in Catalonia, but infections have sometimes occurred through poor implementation of preventive measures. Pregnant women should be offered an HIV diagnostic test not only in the first trimester but also at the end of pregnancy if HIV exposure is suspected. In women with unmonitored pregnancies, rapid diagnostic tests for HIV should be used in the delivery room.     

Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: Diverging care dynamics

How do women and frontline health workers engage in preventing mother-to-child HIV transmission (PMTCT) in urban areas of Vietnam and Indonesia, where HIV is highly stigmatized and is associated with injecting drug use and sex work? This qualitative study explores local dynamics of care, using a mix of observations, focus group discussions, and interviews. In Indonesia the study was conducted in a community-based PMTCT program run by an NGO, while in Vietnam the study explored the care dynamics in routine PMTCT services, implemented by district and provincial public health facilities. In both of these PMTCT arrangements (the routine provider initiated approach in Vietnam and a more client-oriented system in Indonesia), pregnant women value the provision of HIV tests in antenatal care (ANC). Concerns are raised, however, by the unhappy few who test positive. These women are unsatisfied with the quality of counselling, and the failure to provide antiretroviral treatments. Acceptability of HIV testing in ANC is high, but the key policy issue from the perspective of pregnant women is whether the PMTCT services can provide good quality counselling and the necessary follow-up care.We find local level providers of PMTCT are pleased with the PMTCT program. In Vietnam, the PMTCT program offers health workers protection against HIV, since they can refer women away from the district health service for delivery. In Indonesia, community cadres are pleased with the financial incentives gained by mobilizing clients for the program.We conclude that achieving the global aims of reducing HIV infections in children by 50% requires a tailoring of globally designed public health programs to context-specific gendered transmission pathways of HIV, as well as local opportunities for follow-up care and social support.