艾滋病高发地区预防HIV母婴传播项目实施效果分析

Analysis of the effectiveness of program on prevention of mother-to-child transmission of HIV in high HIV-prevalence areas from 2007 to 2010

目的了解艾滋病高流行的4省（自治区）的6个县（市、区）,预防艾滋病病毒（HIV）母婴传播项目的实施效果。方法通过全国预防艾滋病母婴传播信息管理系统,收集2007年1月至2010年9月研究地区艾滋病病毒（HIV）感染孕产妇个案卡及其所生儿童的随访登记卡,分析预防HIV母婴传播干预措施落实情况及效果。结果2007-2010年,研究地区HIV感染孕产妇抗病毒药物应用比例和孕期抗病毒药物应用比例,分别从78.4%和27.8%增加至93.7%和78.8%（趋势χ2=17.636,P〈0.01;趋势χ2=76.835,P〈0.01）;HIV感染孕产妇应用三联抗病毒药物方案的比例自19.8%增加至89.9%（趋势χ2=161.757,P〈0.01）。满18月龄艾滋病感染孕产妇所生儿童接受HIV抗体检测比例为84.8%（318/375）,13例儿童抗体检测阳性,艾滋病母婴传播水平为4.1%（95%可信区间：2.98%-5.20%）。结论研究地区预防HIV母婴传播干预措施落实指标逐年提高,HIV母婴传播水平显著下降,孕产妇及早抗病毒用药以及儿童随访检测仍为工作中的薄弱环节。

Objective To investigate the effectiveness of program on prevention of mother-to-child transmission of HIV （PMTCT） in 6 counties of 4 provinces with relatively high-prevalence of HIV/AIDS. Methods The information on implementation of PMTCT program from Jan 2007 to Sep 2010 was recorded on individual information cards of HIV-infected pregnant women and follow-up information cards of children born to HIV-infected pregnant women. Through the national information management system of PMTCT, the information was collected and effectiveness of the PMTCT program was analyzed. Results In the research sites, from 2007 to 2010, the proportions of HIV-infected pregnant women who took antiretroviral （ARV） drugs and of those who took ARVs before delivery were increased from 78.4 % and 27.8 % to 93.7 % and 78.8 %, respectively （Trendx^2=17. 636, P〈 0.01, Trend x^2= 76. 835,P〈0.01）. The proportion of HIV-infected pregnant women taking triple ARVs raised from 19.80% to 89.9 % （Trend x^2= 161. 757,P〈0.01）. The proportion of children born to HIV-infected pregnant women over 18 months old receiving HIV antibody test was 84.8% （318/375）. There were 13 children detected HIV positive. The mother-to-child transmission （MTCT） rate of HIV was 4.1%（95%CI, 2.98%-5.20%）. Conclusion In research sites, the implementation of PMTCT program was improved yearly, and the MTCT rate was reduced. However, early ARV use among HIV-infected women during pregnancy, and follow-up and HIV antibody test of children born to HIV-infected pregnant women were still the weak points.