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

Cross-sectional study on rates and influencial factors of standard medication for antiretroviral therapy in preventing mother-to-child transmission of HIV

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。

Objective To understand the status of standard medication of antiretroviral therapy and identify its correlationship with preventing mother-to-child transmission of HIV （PMTCT）. Methods Qualitative and quantitative methods for measuring of standard medication towards antiretroviral therapy of PMTCT were used in a cross-sectional study of 167 pregnant women who had accessed to PMTCT services and 57 physicians providing service from January 2005 to June 2007 in 5 HIV epidemic counties in Yunnan province. Results A total of 167 mothers were recruited, of which 65. 87% （ 110/167 ） demonstrated for standard medication. The percentage of rational selection of antivirus-therapy regimen was 88. 02% （ 147/ 167 ）. HIV positive mothers with rational using medicine during labor covered 81.37% （ 131/161 ）. 87.42% （ 146/167 ） of women demonstrated good compliance. The main correlations with the standard medication level of HIV positive pregnant women and their infants were as follows： diagnose time （OR = 2. 617;95% CI： 1. 184 -5. 783 ）, place of delivery （ OR = 0. 064; 95% CI： 0. 007 - 0. 607 ）, minorities （ OR = 0. 344; 95% CI：0. 162 -0. 730）, understanding of HIV women for antiretroviral therapy （OR = 6. 843;95% CI： 1. 449 -32. 312） ,and doctors＇ cognition about the regimen for antiretroviral therapy was not enough; 5 key knowledge points （purpose of PMTCT, the consequence of not requiring standard medication, the effect of knowing regimens, the relationship of CD4 levels and selected regimens, the side effect of the relevant medicine） score rate was 47.72% （ 136/285 ）. Conclusion The proportions of standard medication in PMTCT antiretroviral therapy were not high. Standard medication might be associated with multiple factors from doctors, patients and society. It is necessary to make some steps to improve standard medication of antiretroviral therapy in PMTCT.