我国西部某两个区县预防艾滋病母婴传播随访现状及影响因素研究

Study on follow-up status and its influence factors in HIV prevention on mother-to-child transmission

目的了解我国西部地区HIV感染孕产妇及所生儿童随访现状，发现主要问题及可能的需方影响因素。方法采用前瞻性调查方法，对2005--2012年我国重庆市、贵州省的两个区县发现的所有HIV感染孕产妇及所生儿童进行社会人口学、接受服务情况等调查。结果研究地区HIV感染孕产妇及所生儿童失访率较高，累计达33．8％（25／74），失访主要发生在确认感染至分娩7人（5．6％）和分娩至产后6～8周16人（23．9％）。影响因素分析结果显示，2011～2012年报告病例较2005--2010年报告病例（OR=0．04，95％CI：0．00～0．32）、接受过检测后咨询较未接受检测后咨询者（OR=0．06，95％CI：0．00～0．94）在访比例高，现住址在其他县区或外省者较本县区常住者失访比例高（OR=20．48，95％CI：1．45—289．48）；失访者在年龄、职业、文化程度、婚姻状况、孕产史、感染途径、接受服务时期等其他因素上未显示出与未失访者之间存在不同。结论降低HIV感染孕产妇及所生儿童失访率，应重点关注确认感染至分娩以及分娩至产后6～8周两个时段；亟需进一步研究服务提供因素对随访的影响。

Objective To understand the current follow-up status for HIV positive pregnant women and their children in HIV prevention of mother-to-child transmission （PMTCT） , and explore the main obstacles and possible influence factors for target population in western China. Methods A prospective survey was used to collect data on HIV infected pregnant women and their exposed children in one district in Chongqlng and one county in Guizhou from 2005 to 2012, based on the routine comprehensive HIV PMTCT interventions. Results The rate of Loss to Follow-up （LFU） among pregnant women who were confirmed to be HIV infected and their children was high in the two study sites, cumulated to 33.8% （25/74）. LFU mainly occurred during the phase from confirmation to delivery and from delivery to 6 -8 weeks postpartum. The number and rate of LFU were 7 （5.6%） and 16 （23.9%） , respectively. The influence factors analysis showed that the proportions of un-LFU among those being reported in 2011 and 2012 [ versus in or before 2010, OR = 0. 04 （95% CI： 0. 00 -0. 32） ] , and having received post-test counseling [ versus not receiving post-test counseling, OR ：0. 06 （95% CI： 0. 00 -0. 94） ] were higher, while the proportion of LFU among those living outside study sites （versus living in the sites, OR = 20. 48 （95% CI： 1.45 -289.48）） were higher. There was no differences in age, occupations; level of educations, marriage status, previous pregnancy history, infection route, stage of receiving ANC and PMTCT services between LFU and un- LFU. Conclusion The two stages from HIV positive result confirmation to delivery and fi＇om delivery to the first visit at the 6th - 8th week after delivery are critical to reduce the rate of LFU. The further research about service delivery impact on LFU should be carried out as soon as possible.