艾滋病母婴传播阻断抗病毒治疗依从性及影响因素

目的:探讨艾滋病母婴传播阻断抗病毒治疗的依从性水平与主要影响因素,为制定HIV阳性孕产妇及其所生婴儿抗病毒治疗规范用药的措施提供依据。方法:在云南省5个艾滋病高发县(市、区)及一家省级保健机构对艾滋病母婴传播阻断抗病毒治疗方案的依从性进行了现况调查。结果:抗病毒治疗依从性良好者占91.0%(111/122)。影响HIV阳性孕产妇及婴儿服药依从性的主要因素为医生对HIV阳性孕产妇的态度,医患间的沟通与合作程度,方案的复杂程度,家庭人均收入,家庭支持,是否在县级及以上助产机构住院分娩,以及患者对艾滋病抗病毒治疗方案的认识,对生育的态度。结论:HIV感染孕产妇艾滋病母婴传播阻断抗病毒治疗服药依从性较好,多个因素对HIV感染孕产妇服药依从性有影响。     

山东省艾滋病抗病毒治疗病例服药依从性及相关影响因素调查

[目的]了解山东省艾滋病抗病毒治疗病例服药依从性情况及其相关影响因素。[方法]对山东省2009年4月1日至9月31日正在接受抗病毒治疗的324例艾滋病病例进行治疗依从性及相关因素调查,并对治6个月的病例进行病毒载量检测。[结果]治疗324例病人中,94.75%服药依从性良好;服药依从性差前2位原因为因事耽误(7例)和药物副作用(5例)。227例服药依从性好的病例治疗6个月后,病毒载量400 cp/ml的占88.55%,这一比例在依从性差的12例病人中为66.67%(P0.05)。5例有药物副作用者4例病毒载量值10 000 cp/ml。[结论]山东省艾滋治疗病例服药整体依从性良好,药物的副作用应引起注意。     

218例艾滋病患者抗病毒治疗依从性调查

目的探讨艾滋病（AIDS）患者抗病毒治疗依从水平及其相关影响因素。方法采用整群抽样方式抽取阜阳市开发区AIDS患者,共218人,接受抗逆转录病毒（ART）治疗。调查内容包括患者的人口学特征、药物漏服情况和漏服原因等。结果 218例患者能够按照医生要求的次数,服药量,服药时间及长期坚持从不间断服药的患者,即依从的患者有33名,仅占全部被调查患者的15.1%。AIDS患者接受抗逆转录病毒治疗的依从性在年龄、性别、文化程度、婚姻状况和家庭人口数方面差异无统计学意义（P〉0.05）家庭收入差异有统计学意义,以家庭收入5 000～10 000元/年艾滋病患者服药依从较高（χ2=8.288,P〈0.05）。出现不依从的原因依次是不能够按时服用药物、不能够按照医生要求的次数服药、不能长期坚持服药和不能够按照要求的量服药。出现漏服药物主要的原因是忙于别的事情或忘记服药。结论阜阳市某区AIDS患者的服药依从性较低,需加大工作力度。     

艾滋病抗病毒治疗失败人群服药依从性及影响因素

目的 了解艾滋病抗病毒治疗失败人群的服药依从性及其影响因素。方法 以苏州市2019—2020年抗病毒治疗满6个月后,治疗失败的HIV感染者(病毒载量>1 000 copies/mL)为研究对象,分析人口学特征、对抗病毒药物的认知、社会支持程度等对服药依从性的影响。结果 共纳入治疗失败HIV感染者212人,过去1个月全部按时吃药145人,占68.4%。多因素logistic回归分析显示,住所方便服用艾滋病抗病毒治疗药物(OR=4.59,95%CI:1.05～19.96)和自我报告健康状况好(OR=3.58,95%CI:1.36～9.39)的患者服药依从性较高。结论 苏州市抗病毒治疗失败人员服药依从性较低,服药依从性跟住所服药方便程度和患者自我健康状况等相关。     

天津市中青年艾滋病患者抗病毒治疗依从性及影响因素分析

目的 探讨天津市中青年艾滋病患者接受高效联合抗逆转录病毒治疗(简称:HAART)的依从性及相关影响因素.方法 选择2018年10-12月天津市河东区疾控中心管理的符合纳入排除标准的全部中青年艾滋病患者共277例,通过信息系统并采用问卷调查方式收集相关信息,了解抗病毒治疗依从性情况,采用Logistic回归模型对相关因素...     

艾滋病患者抗病毒治疗依从性相关情况分析

目的 探讨艾滋病患者抗病毒治疗依从性相关情况。方法 选取我院2018年6月—2020年6月诊治的118例艾滋病患者作为研究对象。根据患者对治疗的依从性分为依从性好组（n=65）及依从性差组（n=53）。对患者的服药情况、抗病毒治疗依从性单因素及多因素相关情况进行分析。结果 118例患者中有53例患者出现药物漏服现象,主要漏服原因为患者用药后出现不良反应,占比43.40%,另外还有忘记服药、害怕他人知道自己患有艾滋病、在外服药不及时及其他原因。家人支持、工作、服药知识、饮酒、文化水平、年龄各单因素与患者治疗依从性密切相关（P <0.05）。工作、服药知识是患者治疗依从性的重要独立影响因素（P <0.05）。结论 家人支持、工作、服药知识及饮酒是影响艾滋病患者抗病毒治疗依从性的主要影响因素,应根据患者的实际情况给予相应的治疗措施,提高患者治疗依从性。     

佛山市禅城区艾滋病患者抗病毒治疗服药依从性分析

目的了解广东省佛山市禅城区艾滋病患者抗病毒治疗的服药依从性情况及相关影响因素。方法选择佛山市禅城区中心医院接受HAART治疗的72例HIV感染者作为研究对象,分别对服药情况、漏服药物原因以及服药后不良反应等情况进行问卷调查。结果 72例患者中服药依从性>95%的为50例(69.44%),有37例(51.39%)在最近1个月内出现过漏服药物的情况。导致患者出现漏服药物的前3位原因为:药物不良反应15例(40.54%)、忘记服药8例(21.62%)和担心别人知道自己服用艾滋病治疗药物6例(16.22%)。患者出现的前3位不良反应为头痛和头晕(40.28%),恶心、呕吐、腹泻等胃肠反应(29.17%),药物性皮疹和皮肤瘙痒(23.61%)。不同文化程度的患者药物漏服率之间的差异有统计学意义(χ2=10.296,P<0.05)。结论艾滋病患者抗病毒治疗情况有待提高,而药物不良反应是导致服药依从性降低的主要原因,通过加强依从性教育、完善家庭和社会支持、优化治疗方案等综合措施,可有效提高患者的服药依从性水平。     

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。     

浦东新区艾滋病患者抗病毒治疗信心及服药依从性调查

目的 了解浦东新区艾滋病患者的抗病毒治疗信心及服药依从性情况,分析治疗信心对服药依从性的影响,为进一步提高艾滋病患者服药依从性提供措施和依据。 方法 采用单纯随机抽样的方法,从浦东新区医学随访管理的艾滋病患者中随机抽取部分已治疗的对象开展调查。 结果 共调查艾滋病患者238例,其中男性占94.96%(226/238)。66.39%(158/238)的对象表示自己对抗病毒药物治疗非常有信心,27.31%(65/238)表示比较有信心,信心不足、没有信心的分别占3.36%(8/238)、2.94%(7/238)。89.92%(214/238)的对象近3个月一直保持较好的服药依从性。年龄组和学历对艾滋病人服药依从性有显著的影响,其中30~40岁年龄组以及学历高中以下病人的服药依从性显著低于其他组(P<0.05)。 结论 浦东新区艾滋病患者抗病毒治疗信心及服药依从性较好,可针对特定年龄组以及较低学历的病人采取强化措施进一步提高服药依从性。     

艾滋病母婴阻断抗病毒治疗的临床疗效分析

目的：分析母婴阻断抗病毒治疗艾滋病的临床疗效。方法收集2010---2013年期间,我院收治的 HIV阳性并要求继续妊娠的孕妇93例作为研究对象,应用三联抗病毒药物阻断方案进行治疗。结果本组93例孕妇均于孕周14周开始用药治疗直至产后42d,经治疗后初生婴儿均未见 HIV阳性,随访18个月均呈阴性。结论对于HIV阳性孕妇实施抗病毒药物阻断治疗联合婴儿人工喂养,能够有效阻断HIV的母婴传播,值得推广应用。     

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.     

预防艾滋病母婴传播抗病毒治疗副作用研究

目的 采用回顾性研究方法分析齐多夫定、奈韦拉平联合用药与单剂量奈韦拉平用药方案在预防艾滋病母婴传播中对肝功能和血象的影响.方法 于2005年5月至2006年10月,对人类免疫缺陷病毒感染的孕产妇109例、婴儿82例应用齐多夫定和奈韦拉平联合用药及单剂量奈韦拉平用药方案的情况进行分析;以第6版医学教材中的血象、肝功正常值为参照进行比较;以国际治疗艾滋病药物毒性指南判定肝功的损害程度.结果 在齐多夫定、奈韦拉平联合用药方案中,母亲服药前后血红蛋白、红细胞平均血红蛋白、总胆红素发生改变,新发贫血15例,但未见粒细胞减少病例;婴儿贫血3例、血小板减少2例、粒细胞减少4例;采用单剂量奈韦拉平用药方案中,母亲产时(服药前)和产后42天的总胆红素、直接胆红素、谷丙转氨酶发生改变;婴儿在出生后6个月出现贫血3例,血小板减少3例,粒细胞减少3例.两种方案进行比较,孕产妇产后42天和婴儿出生后3个月肝功各项指标及婴儿出生后6个月红细胞、血红蛋白、血小板均无统计学意义(P＞0.05).结论 两种方案均对母婴血液系统、肝功系统的影响不大.     

Operational effectiveness of single-dose nevirapine in preventing mother-to-child transmission of HIV

OBJECTIVE: To determine the operational effectiveness of the South African programme for preventing mother-to-child transmission (PMTCT) of HIV in reducing rates of early transmission of infection. METHODS: Participants were mother-infant pairs who participated in the South African PMTCT programme between October 2002 and November 2004. This was a prospective cohort study. Three sites in different provinces were selected to represent differences in socioeconomic status and HIV prevalence. Data on antenatal care and labour ward care were obtained from maternal interviews and from reviews of medical records. A total of 665 mother-infant pairs in which the mother was HIV-positive were recruited and 588 (88.4%) were followed up at 3 or 4 weeks postpartum to determine the HIV status and vital status of the infant. FINDINGS: Rural participants were significantly poorer and their health care was significantly worse. Women of higher socioeconomic status and those who received better counselling were more likely to be treated with nevirapine. Rates of early HIV transmission ranged from 8.6% to 13.7%. Maternal viral load was the only statistically significant risk factor for transmission. After adjusting for maternal viral load and prevalence of low birth weight, the odds of transmission were 1.8 times higher at the rural site. Controlling for having had > or = 4 antenatal visits and any delivery complication reduced the odds of transmission to 1.5 higher at the rural site. CONCLUSION: Rates of early transmission of HIV in an operational setting using single-dose nevirapine administered both to mother and child are similar to those obtained in clinical trials. Scaling up access to antiretroviral regimens for women will further reduce transmission to infants.     

Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda

Objective

To model the cost-effectiveness in Uganda of combination antiretroviral therapy (ART) to prevent mother-to-child transmission of human immunodeficiency virus (HIV).

Methods

The cost-effectiveness of ART was evaluated on the assumption that ART reduces the risk of an HIV-positive pregnant woman transmitting HIV to her baby from 40% (when the woman is left untreated) to 25.8%, 17.4% and 3.8%, respectively, when the woman is given: (i) single-dose nevirapine (at an estimated total drug cost of 0.06 United States dollars [US$]); (ii) dual therapy with zidovudine and lamivudine for 7 weeks (at a total drug cost of US$ 15.63); or (iii) ART for 18 months (at a total annual cost of US$ 469.77). Lifetime ART (US$ 6883), recommended for pregnant women with < 350 CD4+ T lymphocytes per mm³, was assumed to give the same reduction in transmission risk in each subsequent pregnancy.

Findings

Compared with single-dose nevirapine, dual therapy and no therapy, 18 months of ART averted 5.21, 3.22 and 8.58 disability-adjusted life years (DALYs), respectively, at a cost of US$ 46, US$ 99 and US$ 34 per DALY averted. The corresponding figures for lifetime ART are, respectively, 19.20, 11.87 and 31.60 DALYs averted, at a cost of US$ 205, US$ 354 and US$ 172 per DALY averted.

Conclusion

In Uganda, ART appears highly cost-effective for the prevention of mother-to-child HIV transmission, even if continued over the patients’ lifetimes. Given the additional public health benefits of ART, efforts to ensure that all HIV-positive pregnant women have access to lifelong ART should be intensified.     

HIV母婴传播影响因素及我国预防HIV母婴传播对策

预防艾滋病母婴传播是艾滋病防制的重要组成部分。文章分析了HIV母婴传播影响因素，总结了我国预防HIV母婴传播对策与措施，并探讨了我国预防HIV母婴传播应注意的几个问题。     

预防艾滋病母婴传播的研究进展

感染艾滋病病毒的生育年龄妇女人数在迅速增加,并严重威胁到儿童,HIV感染儿童中绝大多数源自母婴传播.预防艾滋病母婴传播,已经成为许多发展中国家优先考虑的公共卫生领域.本文就预防艾滋病母婴传播现状与研究进展做一简要概述.     

The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review

Background

Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. We reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT) of HIV in low- and middle-income countries (LMICs). This article presents syntheses of evidence on the costs, effects and cost-effectiveness of HIV MTCT strategies for LMICs from the published literature and evaluates their implications for policy and future research.

Methods

Candidate studies were identified through a comprehensive database search including PubMed, Embase, Cochrane Library, and EconLit restricted by language (English or French), date (January 1st, 1994 to January 17^th, 2011) and article type (original research). Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion. We searched article bibliographies to identify additional studies. Two authors independently assessed eligibility and extracted data from studies retained for review. Study quality was appraised using a modified BMJ checklist for economic evaluations. Data were synthesised in narrative form.

Results

We identified 19 articles published in 9 journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks. In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health.

Conclusions and Recommendations

Interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Future cost-effectiveness analyses can help to ensure that pMTCT interventions for LMICs reach their full potential by focussing on unanswered questions in four areas: local assessment of rapidly evolving HIV MTCT options; strategies to improve coverage and reach underserved populations; evaluation of a more comprehensive set of MTCT approaches including primary HIV prevention and reproductive counselling; integration of HIV MTCT and other sexual and reproductive health services.