云南省消除艾滋病病毒母婴传播工作机制及效果评价

Elimination of mother-to-child transmission of HIV in Yunnan province: an evaluation on 14-year process

目的分析评估云南省消除艾滋病病毒(HIV)母婴传播工作措施的效果,总结云南省消除HIV母婴传播工作机制,为其他地区实现消除HIV母婴传播目标提供科学依据。方法使用文献回顾法,收集云南省自2006年起实施的预防及消除HIV母婴传播工作措施与预防策略,通过全国预防HIV母婴传播信息管理系统,收集云南省2006—2019年全省HIV感染孕产妇及所生儿童的个案卡与随访登记卡,云南省2006—2019年预防HIV母婴传播工作月报表,计算评价指标以分析各项工作措施的实施效果。结果云南省建立了保障孕产妇HIV抗体检测、HIV感染孕产妇及所生儿童抗病毒治疗、保健、随访检测措施落实的"逢孕必检"、"转介制度"、"专人管理"、"感染个案评审"、"信息监测与管理"等工作制度与运转机制,孕产妇HIV抗体检测率从79.09%提高至99.97%,孕期HIV抗体检测率从44.56%提高到99.89%,HIV感染产妇抗病毒治疗比例从75.92%提高至99.72%,HIV感染产妇所生儿童抗病毒治疗比例从86.90%提高至99.91%,艾滋病母婴传播率(校正)从项目实施初期的8.78%下降到1.93%。结论云南省消除艾滋病母婴传播工作机制可保障预防艾滋病母婴传播干预措施有效落实,保障与促进云南省消除艾滋病母婴传播工作达到世界卫生组织艾滋病母婴传播消除认证中的基本指标要求,可供其他省份和周边国家借鉴。

Objective To evaluate the effect and mechanism of intervention measures for the elimination of mother-tochild transmission(MTCT) of human immunodeficiency virus(HIV) in Yunnan province from 2006 to 2019 for providing evidences to the control of MTCT of HIV in other regions. Methods Information on implemented strategies and measures for prevention of MTCT of HIV in Yunnan province since 2006 were collected with literature reviews. Case records and follow-up registration cards for HIV-infected puerperae and their newborns and monthly reports for the prevention of MTCT of HIV in Yunnan province from 2006 through 2019 were extracted from National Information Management System for Prevention of MTCT of HIV. The collected data were analyzed statistically and relevant indicators were calculated to evaluate the efficiency of the implemented strategies and measures in the province. Results Relevant management process and system were established in the province to ensure the implementation of HIV antibody testing in all pregnant women and all measures for HIV-infected puerperae and their newborns including anti-viral treatment, health care, follow-up detection,referral, individualized management and infection assessment, and information monitoring. From 2006 to 2019, the detection rate of HIV antibody in pregnant women increased from 79.09% to 99.97% and the HIV antibody detection rate during the pregnancy increased from 44.56% to 99.89%;the rate of anti-viral treatment among HIV-infected puerperae and their children increased from 75.92% to 99.72%, and from 86.90% to 99.91%, respectively;whereas, the adjusted the rate of MTCT of HIV decreased from 8.78% to 1.93%. Conclusion In Yunnan province, the strategies and measures implemented from 2006 to 2019 for elimination of of MTCT of HIV were effective and major outcome indicators for the control of MTCT of HIV met the requirements proposed by World Health Organization.