HIV感染儿童的母亲预防艾滋病母婴传播服务障碍分析

Barriers analysis on maternal health care among HIV infected children's mother

目的了解HIV感染儿童的母亲孕产期接受孕产期保健服务和预防艾滋病母婴传播服务的状况,为提高云南全省预防艾滋病母婴传播服务覆盖面提供科学依据。方法从云南省艾滋病综合防治数据信息系统中获得调查对象基本信息,统一培训后,使用自行设计的问卷通过一对一、面对面的询问方式,回顾性调查HIV感染儿童的母亲孕产期接受保健服务和预防艾滋病母婴传播服务的有关信息。结果 1HIV感染儿童母亲及父亲文化程度偏低,职业以农民为主,主要居住在云南省高疫情地区,母亲孕期产检比为53.17%,住院分娩比例为62.70%;孕产期HIV检测比例为46.83%,HIV阳性检出比为38.14%。不同类型医疗机构间HIV咨询检测服务质量存在较大差距。2HIV感染儿童母亲未进行产前检查的原因主要为"不知道怀孕后需要进行产检",孕产期未进行HIV检测的主要原因依次为"未到医疗机构产检或住院分娩"、"产检或住院分娩时医生未提供检测"。HIV抗体阳性孕产妇拒绝服用抗病毒药物的主要原因是对预防HIV母婴传播工作缺乏了解和信任。结论 HIV感染儿童的母亲缺乏孕产期保健意识,孕产期保健服务利用不足,医疗机构尤其是民营医疗机构的HIV咨询检测服务不规范,影响HIV感染孕产妇的及时发现和HIV感染孕产妇抗病毒药物应用。建议探索有针对性的服务模式,提高基础妇幼保健和预防艾滋病母婴传播工作的可及性。

Objective To understand the Status of maternal health care services and prevention of mother-to-child transmission of HIV（ PMTCT） among HIV-infected children’s mothers,and to provide scientific evidence for improving the coverage of PMTCT services in Yunnan. Methods The basic information of HIV-infected children was obtained from the data information system of AIDS prevention and control in Yunnan province. By using a self-designed questionnaires,and interviewing face-to-face,the information on receiving antenatal care（ ANC） and PMTCT services of children’s mother was collected. Results 1 The education level of the parents of HIV-infected children was relatively low,and the most of them were mainly peasants and from areas with higher HIV prevalence. The proportion of mothers who received ANC was 53. 17%; the rate of delivery in Hospital was 62. 70%; the rate of HIVtesting was 46. 83%,the HIV prevalence was 38. 14%. 2 The main reason for those mothers did not attend ANC was they ＂didn’t know that prenatal care was necessary＂,and the main reason for not taking HIV test was＂did not deliver in the medical institutions or in hospitals＂,or＂the doctors did not provide the test ＂. The main reason of HIV-infected pregnant women refused to take antiretroviral（ ARV） drugs was the lack of understanding and trust on PMTCT of HIV. Conclusions HIV-infected children’s mothers lacked the awareness of ANC and didn’t sufficiently utilized ANC services. The HIV-testing and proper adherence to ARVs regime of HIV-infection children’s mother are influenced by non-standard HIV consulting services,especially in private medical institutions. It is necessary to explore the specific service model to improve the accessibility of primary maternal and child health care and PMTCT services.