马拉维360例艾滋病孕产妇母婴传播的干预措施及效果分析

Intervention measures and effect for mother-to-child transmission among 360 cases of maternal AIDS in Malawi

目的分析马拉维对艾滋病孕产妇母婴传播干预措施的现状及效果。方法选择2012年3月至2013年5月确诊的360例艾滋病病毒(HIV)感染孕产妇,从规范使用抗反转录病毒(ART)药物、分娩方式和喂养方式三方面来干预,并对360例HIV感染孕产妇及其分娩的婴幼儿的HIV感染状态定期追踪随访。结果规范应用ART药物者,其母婴传播率为5.31%(17/320),同国内相仿,低于不规范服药者和未服药者的母婴传播率15.00%,两者差异有统计学意义(χ2=4.08,P<0.05)。分娩方式中,剖宫产(急诊剖宫产和择期剖宫产)的母婴传播率为4.76%(4/84),略低于阴道分娩母婴传播率5.07%(14/276),两者差异无统计学意义(χ2=0.03,P>0.05)。在规范使用ART药物及安全分娩前提下,母乳喂养的母婴传播率为14.71%(40/272),人工喂养的母婴传播率为4.17%(2/48),两者差异有统计学意义(χ2=3.97,P<0.05)。规范应用ART药物和人工喂养的孕产妇,其艾滋病母婴传播率为4.17%(2/48),与未采取任何预防措施的艾滋病母婴传播率21.43%(3/14)相比,母婴传播率下降了80.54%。结论提早发现,规范用药、安全分娩及人工喂养,综合预防艾滋病母婴传播,才能有效降低艾滋病母婴传播水平。

Objective To analyze the present situation and effect of intervention measures for reducing the risk ofmother-to-child transmission of HIV/AIDSin Malawi. Method To select the 360 cases of maternal HIV infection who were confirmed from March 2012 to May 2013, and to intervene from three aspects including the standard use of antiretroviral （ARV） drugs, delivery mode and feeding mode. HIV infection status in 360 cases of pregnant HIV- infected women and their infants were followed-up regularly. Results In HIV-infected pregnant women with stand- ard use of ARV drugs, the mother-to-child transmission （MTCT） rate was 5.31% （17/320）, it was similar with the domestic, and was less than that in HIV-infected pregnant women with non-standard use of drugs and no use drugs 15. 00% （6/40）, （X^2 = 4.08, P〈0.05）; the difference was statistically significant. The MTCT rates of dif- ferent delivery modes were cesarean section （emergency cesarean section and elective cesarean ） 4.76% （4/84）, spontaneous vaginal delivery 5.07% （14/276）, （x^2 = 0.03, P〉0.03）, respectively. There was no statistically sig- nificant difference between them. Under the premise of the standard use of ARV drugs and safe delivery, compare of breastfeeding and artificial feeding, the rates of MTCT in breastfeeding and artificial feeding was 14. 71% （40/ 272）, 4.17% （2/48）, （x^2 =3.97, P〈0.05）, respectively, the difference was statistically significant. In the cases of standard use of ARV drugs and artificial feeding, the MTCT rate was 4.17%（2/48）, lower than that in the ca- ses without taking any preventive measures 21. 43% （3/14）. Conclusion Early detection, standard use of ART drugs, safe delivery and artificial feeding, integrated prevention of MTCT of AIDS, were the effective invention measures for reducing AIDS from MTCT.