南阳市395例HIV阳性孕产妇预防艾滋病母婴传播干预措施及影响因素分析

Analysis on the adoption of mother-to-child transmission intervention and related influencing factors among HIV-positive pregnant women in Nanyang

目的分析南阳市预防艾滋病母婴传播措施落实情况及影响因素,评价预防效果,为艾滋病母婴传播的预防与研究提供依据。方法对2003-2016年发现的395例HIV阳性孕产妇接受预防艾滋病母婴传播干预措施及影响因素进行分析。结果 395例孕产妇中,分娩为主要妊娠结局,占73.68%,自愿人工终止妊娠占26.33%;多因素Logistic回归分析显示终止妊娠比例随着孕产妇年龄增大而增高(OR=2.105,95%CI:1.229~3.605),随HIV初检孕周的增多而降低(OR=0.394,95%CI:0.294~0.53),离异丧偶者终止妊娠比例高于已婚者,经血液和母婴途径传播终止妊娠比例高于经性传播者,差异有统计学意义(χ2=11.201,P<0.05);发现孕周越早,母亲用药率越高(χ~2=79.857,P<0.05),母亲用药方案也随HIV发现孕周差异有统计学意义(χ~2=29.231,P<0.05),234例可随访到的婴儿,阴性224例,阳性10例,接受干预措施后的母婴传播率为4.27%。结论南阳市自2003年开展预防艾滋病母婴传播工作,干预效果显著;做好孕早期HIV抗体检测工作是预防艾滋病母婴传播的关键;孕早期检测的宣传教育十分必要,要加强对基层医疗机构相关专业人员沟通、咨询技巧的培训工作。

Objective The aim of this study was to investigate the implementation of the program for preventing mother-to-child HIV transmission in Nanyang, in order to evaluate the effectiveness and provide a certain basis of the intervention. Methods A total of 395 HIV-positive pregnant women were identified in Nanyang from 2003 to 2016. In this study, the intervention strategies and influence factors were collected and analyzed. Results Among the 395 HIV-positive pregnant women, 73.68% of them decided to deliver and 26.33% of them decided to take abortion. The multivariate logistic regression model showed that the rate of abortion was positively correlated to the age of the pregnant women（OR=2.105, 95 %CI： 1.229-3.605）. And the rate of abortion was negatively correlated to the gestational week during the first prenatal care（OR=0.394, 95 %CI： 0.294-0.53）. The rate of abortion of the divorced and widowed was higher than the married, and the rate of abortion of the HIV-positive pregnant women throng blood or mother-to-child transmission was higher than the HIV-positive pregnant womenthrough sexual, and the difference was statistically significant（P0.05）; The earlier the gestational week during the first prenatal care, the higher rate of mothers adopting the treatment（χ^2=79.857,P 0.05）. Along with the gestational week during the first prenatal care,the treatment options of the HIV-positive pregnant women was significantly different（χ2=29.231,P0.05）.Among the 234 live-born infants, all on the HIV antiretroviral treatment, 224 cases were negative, 10 cases were positive, with a prevalence of 3.5 %. Conclusions From 2003, Nanyang initiated the program of preventing mother-to-child HIV transmission. This study demonstrated the proper implementation of the program and the effectiveness. Detection of HIV infection during pregnancy is substantial for the prevention of mother-to-child HIV transmission. It is essential to have a propaganda and education of pregnant early detection; To strengthen the trainings of the communication and consulting skills for the doctors related this professional in the grassroots medical institutions is necessary.