HIV感染孕产妇启动抗病毒治疗情况及影响因素分析

Initiation of antiretroviral treatment among HIV-infected pregnant women and associated factors

目的 HIV感染孕产妇抗病毒治疗比例是妇女发展纲要重点考核指标,我省该项指标达标情况不容乐观,本研究主要分析我省近20年HIV感染孕产妇抗病毒治疗率及其影响因素,为提高我省治疗率提供科学依据。方法通过《预防艾滋病、乙肝、梅毒母婴传播管理信息系统》下载2004—2020年期间HIV确诊阳性的孕产妇的EXCEL数据库,包括孕产妇基本信息、丈夫或性伴侣信息、孕产妇抗艾滋病病毒药物使用情况等。采用Pearsonχ^(2)检验、Poisson回归模型分析数据。结果 2004—2020年我省共报告834名HIV感染孕产妇病例,平均年龄为(28.65±6.39)岁。我省HIV感染孕产妇孕产期启动抗病毒治疗(antiviral therapy, ART)率呈现逐年增长趋势,从2004—2010年期间的57%(61/107)增长到2020年的95%(19/20,趋势χ^(2)=47.658,P<0.001)。多因素Poisson回归模型分析结果显示,与产后确诊的孕产妇相比,孕前、孕期、产时确诊的孕产妇启动ART的可能性分别增大了5.15倍(95%CI:2.91~9.13)、5.06倍(95%CI:2.85~8.97)和1.83倍(95%CI:1.00~3.64)。结论本研究结果提示,可通过加强孕产妇的管理,将发现孕产妇感染的时期前移至孕前,这对提高艾滋病母婴阻断效果具有重大意义。

Objective The proportion of antiretroviral treatment among HIV-infected pregnant women is an important evaluation index for the program of china’s women development. However, the anticipated goals of such programs are difficult to achieve in Anhui province. This paper aimed to analyse the proportion of antiretroviral treatment among HIV-infected pregnant women and related influencing factors and provide support for promoting the proportion. Methods Data were abstracted from an information system for the prevention of mother-to-child transmission(PMTCT) of acquired immunodeficiency syndrome(AIDS), hepatitis B and syphilis from 2004 to 2020. The data included basic information about the husbands or sexual partners of the pregnant women and initiation of antiretroviral treatment(ART). Pearson chi-square test and Poisson regression model were used in analysing the data. Results A total of 834 HIV-infected pregnant women were reported in Anhui province, with an average age of 28.65±6.39 years. The initiating ART rate among HIV-infected pregnant women increased from 57%(2004-2010) to 95%(2020), χ^(2)=47.658, P<0.001. The result of Poisson regression model revealed that the HIV-infected pregnant women diagnosed before pregnancy(95% CI: 2.91-9.13), during pregnancy(95% CI: 2.85-8.97) and during the intrapartum period(95% CI:1.00-3.64) were less likely to initiate ART than those diagnosed in the postpartum period. Conclusion Our results suggest that the confirmed time of HIV can be advanced by strengthening the management of pregnant women and useful in alleviating the effect of the PMTCT of AIDS.