Factors of Failure of Community Interventions of PMTCT Activities in Haut Katanga in the Democratic Republic of Congo

The objective of the study was to identify the failure factors of community interventions in terms of HIV activities in the province of Haut-Katanga during the year 2016. Materials and Methods: The study was phenomenological of the factors, carried out in Haut Katanga. All health facilities (FOSAs) having integrated the prevention of transmission of HIV infection from mother to child (PMTCT) were included in the study. The collection was carried out through individual semi-structured interviews with PMTCT focal points, mentor mothers and people living with HIV (PLWHA) cared for in some of these health facilities (FOSAs). The number of participants was determined by the saturation of responses. Nvivo v.11 software was used for the analyses. The data of each woman was handled confidentially. The authorization of the ethics committee of the University of Kinshasa ESP/CE091/2015, the free and written consent, was obtained before collecting the information. Results: It was observed the socio-cultural factors of success and failure of the interventions: the social fear generated by contradictory messages in the sensitization of the community;the lack of an obvious strategy for the involvement of the partner;the weak coordination of community care activities between the central office of the health zone;the FOSA and the community worker: low interest in community care evidenced by weak accountability of FOSAs, community and program providers in this regard;that relates to community activities;coordination of care between care units;overload of the staff in charge of activities within the health structure and their low motivation;the low communication time devoted to people living with HIV in the FOSAs. Conclusion: The study shows that interventions that can improve the quality and outcomes of prevention of mother-to-child transmission of HIV (PMTCT) services can be directly linked to the program itself, as well as come from another or the community, which generally remains the weak link in which efforts are even less noticeable, at least as far as PMTCT is concerned. Integrating care data for the mother-child couple improve the continuum of services between the different care units as well as the quality of data management.

HIV Status Disclosure Rate to a Sexual Partner, Associated Factors and Outcomes among Pregnant Women in PMTCT Care in Two Large HIV Facilities in Abuja, Nigeria

HIV status disclosure to partners is critical in improving the health and well-being of mother-infant dyad in the prevention of HIV transmission from mother to child (PMTCT) program. This study assesses the HIV disclosure rate to intimate partners, associated factors, and outcomes among women in the PMTCT program in two large HIV clinics in Abuja, Nigeria. A descriptive cross-sectional study employed a multi-stage sampling technique in selecting 220 pregnant women enrolled in PMTCT care in two clinics. Outcomes measures include HIV status disclosure to intimate partner, women’s viral suppression status (suppressed < 1000 copies/mL, unsuppressed ≥ 1000 copies/mL), and previous MTCT experience. Exposure variables include the participant’s socio-demographic characteristics and HIV care history. Data were presented using frequency tables. Simple and multivariate logistic regression was done to ascertain the predictors of HIV status disclosure and assess the association between HIV disclosure, viral suppression, and MTCT experience at a p-value of less than 0.05. Only 205 (96.7%) entries were completed and analyzed A larger percentage of the participants were married women, 158 (77.1%), within the age group 26 - 35 years (53.3%). Women’s HIV status disclosure rate to intimate partners was 49.3% (101/205). Factors associated with HIV disclosure rate to intimate partners at the univariate level were the participant’s age, Christian religion [COR: 1.80, 95%CI: 1.04 - 3.21, p = 0.04], full employment [COR: 1.92, 95%CI: 1.10 - 3.34, p = 0.02], HIV positivity prior to PMTCT enrollment [COR: 2.88, 95%CI: 1.26 - 6.59, p < 0.01], duration on antiretroviral therapy [COR: 1.07, 95%CI: 1.01 - 1.13, p = 0.03], and knowledge of partner’s HIV status [COR: 0.20, 95%CI: 0.08 - 0.51, p < 0.01]. Only HIV positivity prior to PMTCT enrollment [AOR: 3.27, 95%CI: 1.23 - 8.70, p < 0.01] and awareness of the partner’s HIV status, [AOR: 0.17, 95%CI: 0.06 - 0.49, p < 0.01] were significant predictors of HIV status disclosure after controlling for confounder. The two study outcomes;women’s viral suppression and MTCT experience were not significantly associated with participants’ HIV status disclosure to intimate partners. Our study shows that HIV disclosure to intimate partners is still a big challenge among pregnant women in PMTCT settings in Nigeria, with awareness of the partner’s HIV status and the type of patient enrollment in the PMTCT setting being the two strong predictors of pregnant women’s HIV disclosure status to partners.

Calculating the Number of Pregnant Women Receiving Standardized Services for PMTCT of HIV in Liangshan Prefecture,Based on the Equivalent Method

Objective To calculate the number of pregnant women who receive standardized prevention of mother-to-child transmission(PMTCT)services for HIV annually.Methods HIV-positive pregnant women in six counties of Liangshan Prefecture in 2017 were selected as study subjects.The entire process,from when the subjects first received the PMTCT of HIV services to the end,was divided into four stages,which were further divided into 25 phases.The equivalent coefficient was used to indicate the weight of workload in each phase.Seven experts were invited to score the equivalent coefficient;the number of pregnant women who received standardized services to prevent the transmission of HIV was calculated.Results A total of 663 HIV-positive pregnant women were registered in six Liangshan Prefecture counties in 2017.This figure was converted into 7,780 person-months devoted to HIV-positive pregnant women,with 260 person-months(3.34%)spent on the first antenatal care,1,510 person-months(19.41%)during pregnancy,378 person-months(4.86%)on delivery,and 5,632 person-months(72.39%)on post-partum period.The equivalent coefficient calculation showed that 314 HIV-positive pregnant women received standardized PMTCT services.Conclusion The number of pregnant women receiving standardized services for the PMTCT of HIV can be calculated accurately using the equivalent method to identify the gap between the level of PMTCT of HIV intervention services needed and the actual workload.

Evaluation of the Implementation of the WHO’s 2010 Guide on Prevention of Mother To-Child Transmission (PMTCT) of HIV/Aids: Case of Two Hospitals in Yaoundé

Introduction: The prevalence of HIV infection amongst pregnant women in Cameroon is 5.6%. Mother-to-child transmission is a major expansion factor. In 2010, Cameroon adopted new strategies pegged to WHO guidelines. Objectives: The objective of this study was to evaluate the implementation of the new guidelines of prevention of mother to-child transmission (PMTCT) of HIV in the Yaoundé Central Hospital and the Yaoundé Teaching Hospital. Methodology: It was a cross sectional descriptive and prospective study over a period of 6 months in Yaoundé. It included all HIV-positive women, doing their antenatal care in the above cited hospitals, and having given their consent. The studied variables included socio demographic features, obstetrical history, the antenatal care, the initiation of anti retroviral (ARV) drugs, the ARV regimen, the number of years on ARV drugs, the mode of delivery and the mother and child outcome. The data was collected using a pre-tested questionnaire. They were obtained by interview of the seropositive pregnant women. Data were analysed using Epi info 3.5.3. Results: We performed 3104 antenatal consultations and 287 women were recruited in the study. The prevalence of HIV infection was 9.24%. The mean age of women was 28.77 (SD: 5.13) years. The women were aged between 20 and 29 years in 51.20%. Amongst the 156 women who knew their status before pregnancy, 109 (70.50%) had their first ANC in the first trimester. All were managed according to the 2010 WHO recommendations on PMTCT of HIV. Amongst the women unaware of their status, 25.20% had their booking ANC in the first trimester, 25.14% started ARVs at 14 weeks, 69.46% at 28 weeks. We had 125 live births, 84.8% by vaginal route, neonatal prophylaxis in all babies was effective. Conclusion: PMTCT of HIV is available and guidelines are well applied in Yaoundé. Late treatment initiation still remains a problem to optimize care.

Missed Opportunities for Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Ibadan, Southwest Nigeria

Background: Nigeria has the largest paediatric HIV-infected population in the world. Missed opportunities for prevention of mother-to-child transmission of HIV (PMTCT) compromise efforts at eliminating new pediatric HIV infections. Methods: Six hundred children, aged < 15 years, presenting to the pediatric units of the University College Hospital (UCH), Ibadan Southwest Nigeria between June to December 2007 were studied. The demographics, HIV status and socioeconomic status of mothers and their children were studied. A 4-step hierarchy was used to assess the missed opportunities for PMTCT. Step 1: utilization of a health facility for antenatal care and delivery;Step 2: maternal HIV status determination during pregnancy;Step 3: provision of antiretroviral medication to HIV-infected mother and baby;and Step 4: avoidance of mixed feeding in HIV-exposed children. The rates of missed opportunities for PMTCT services at different steps in the PMTCT cascade, perinatal transmission rates, and associated factors were reported. Results: There were 599 mothers and 600 children (one set of twins), 60 (10%) were HIV infected and 56 (93.3%) of these were adjudged perinatally infected. Of 78 HIV-infected women, 7 (9.0%) accessed all interventions in the PMTCT cascade and 71 (91.0%) had missed opportunities for PMTCT. Missed opportunities for PMTCT occurred 42.9% in cascade Step 1, 64.2% in Step 2, 52.6% in step 3 and 73.7% in Step 4. All mother-baby pairs who accessed complete PMTCT interventions received care at a teaching hospital. Among infants with perinatal HIV infection, 53 (94.6%) were born to mothers who had missed opportunities for PMTCT. Most women with missed opportunities attended antenatal care outside the teaching hospital setting and belonged to low socioeconomic status. Conclusion: It is imperative to expand PMTCT access to women who receive antenatal care outside the teaching hospitals and to those of low socioeconomic status.

The Intersectionality Framework and Its Contribution to Nursing Knowledge Related to the Prevention of Mother to Child Transmission (PMTCT) Program

Nurses work within a multidimensional scope of practice, which includes a reactive approach of treating health problems, a proactive stance of health promotion, and disease prevention. The purpose of this paper is to discuss the contribution of the intersectionality framework in building nursing knowledge related to the PMTCT of HIV and show how the intersectionality framework can contribute to the improvement of nursing practice, policy, and research related to PMTCT of HIV. A comprehensive literature review was conducted to be able to discuss the contribution of intersectionality framework in nursing knowledge. Intersectionality is a nice perspective that gives insight into different identities that link and work together to provide inequalities. Intersectionality is a well-suited approach in a nursing profession where we strive to offer efficient and better care to our patients or clients;an excellent tool to explore more on the roots of inequality, oppression, and discrimination.

基于PMTCT模式的梅毒母婴传播控制效果

目的探讨基于预防传染性疾病母婴传播(PMTCT)模式的梅毒母婴传播控制效果。方法选取10600例于我院进行产检的孕妇作为研究对象,根据产检时间将2018年1月至9月的5300例孕妇设为研究组(基于PMTCT模式管理),将2016年1月至9月的5300例孕妇设为参照组(常规模式)。比较两组的管理效果。结果研究组与参照组的妊娠合并梅毒孕妇分别为17、16例。研究组规范治疗率高于参照组,不良妊娠结局总发生率低于参照组(P<0.05)。结论基于PMTCT模式管理对梅毒母婴传播控制效果显著。

Postnatal PMTCT: Women’s Perception Barriers at a Johannesburg Health Centre, South Africa

Background: Maximising women’s participation and ensuring optimal outcomes will require that the women’s perception barriers to postnatal prevention of Mother-to-Child Transmission (PMTCT) programme of HIV be addressed. However, little is known about women’s perception barriers to postnatal PMTCT programme of HIV and how these barriers affect the women’s health seeking behavior and uptake. Objective: This study sought to explore the women’s perception barriers to postnatal PMTCT programme at a Johannesburg Community Health Centre during April-May, 2016. Methods: A qualitative study on 30 women (aged 20 - 39 years) was conducted at a Johannesburg community health (CHC), South Africa, during May-June 2016, after obtaining their consent. The data was analysed thematically to understand women’s perception barriers to postnatal PMTCT programme. Results: The study found that inadequate counselling was perceived to be the single key health service barrier to PMTCT programme. At the individual level, adherence to ART was considered the leading women’s barriers to the postnatal PMTCT. Exclusive breastfeeding was, however, perceived as important women’s barriers to the postnatal PMTCT. Inadequate emotional support from families and community was a noteworthy women’s perception barrier to the programme. Conclusion: The study makes two recommendations: firstly, the staff, programme managers and health policy makers need to be aware of the women’s perception barriers to the postnatal PMTCT programme. Secondly, the programme should be strengthened by addressing perception barriers to the programme to enhance women participation to ensure optimal outcomes for women and their infants.

Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) Visits and Associated Programmatic Predictors: A Pilot Study

Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = &minus;0.73, p = 0.029) and level of satisfaction with PMTCT services (β = &minus;0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = &minus;2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.

Use of Critical Ethnography to Study the PMTCT Program

Background: Despite the efforts at establishing Prevention of Mother to Child Transmission (PMTCT) programs in Rwanda, there are still children who are becoming infected through mother-to-child transmission of HIV. The purpose of our research study was to explore the experiences of HIV positive women using PMTCT program to prevent HIV transmission in Rwanda. Methodology: In this study, a qualitative approach using a critical ethnographic design was used to answer to our research question and with the aim to discover the meaning, process, and context of the studied phenomenon. In this paper, we discussed ethnography, critical ethnography, and its related philosophical assumptions as well as illustrating the rational for the use of critical ethnography to study the PMTCT program. Critical ethnography ultimately will contribute to raising awareness on how we can prevent new infections among children born from HIV positive mothers who are using the PMTCT program. The findings suggested a wide range of challenging factors that are shaped by social, political, cultural, economic, ethnic, and gender values, and that directly and indirectly affect the uptake of the PMTCT program. While using the critical realist ontology, we discovered multiple truths about the challenging factors for HIV+ mothers experience to uptake the PMTCT program. We triangulated their experiences with the findings gathered from healthcare providers, PMTCT leaders and policymakers, field observation, and document analysis. No previous studies on this phenomenon used a critical lens to explore the reality behind a wide range of experiences of mothers using the PMTCT program to prevent HIV transmission in Rwanda. Conclusion: The critical nature of this inquiry contributed to the depth and breadth of knowledge related to the delivery of the PMTCT program to prevent MTCT of HIV.

HIV Prevalence amongst Pregnant Women Clients Attending Antenatal Clinic at the Faith Alive Foundation and PMTCT Centre, Jos Plateau State

Introduction: HIV infection and AIDS is a public health problem worldwide, particularly affecting the populace in resource challenged setting like sub-saharan Africa. Women of reproductive age are mostly affected and infected with the HIV disease. Methodology: A cross-sectional study of 216 randomly selected women that booked for antenatal care at the Faith Alive Foundation and PMTCT centre Jos between 1st July to 31st December, 2014 was carried out. Information regarding age, parity, gestational age at booking, educational status and HIV sero-status of the clients was analysed. Screening test was conducted in a serial two step approval using determine and UNIGOLD as the confirmatory test, while STAT-PAK was the tie-beaker with discordant result as per the national algorithm. Positive samples were confirmed by western blot method. Result: A total of 18 women out of the 216 women studied were positive giving a sero-prevalence rate of 8.3%. The highest sero-prevalent rate was amongst 25 - 29 years age group (31.5%). Women of parity 1 - 4 constituted the highest group of 62.9%. Majority of the women 65.7% booked in the second trimester while 26.9% booked in the 3rd trimester. Most of the women 47.2% had secondary school education while only 5.6% of them had no form of education. Conclusion: HIV infection prevalence rate among antenatal attendants at Faith Alive Foundation and PMTCT centre Jos is still high. Multisectorial approach and intervention strategies should be further scaled up for the prevention of vertical transmission of the virus. However, it is worth noting that it is mainly an HIV/AIDS hospital which should have affected the outcome.

应用PMTCT模式阻断梅毒母婴传播的效果评价

目的评价预防艾滋病母婴传播(PMTCT)模式预防先天性梅毒的效果。方法采用PMTCT模式对2012—2013年在舟山市妇幼保健院进行孕期保健管理的妊娠合并梅毒孕妇58例为实验组,同期采用常规干预模式管理的妊娠合并梅毒孕妇45例作为对照组,比较两组人群妊娠合并梅毒的诊断、规范治疗及妊娠结局。结果实验组早期发现并诊断的比例明显高于对照组(P<0.05)。实验组规范治疗率为81.03%,高于对照组的62.22%(P<0.05)。实验组和对照组人群不良妊娠结局发生率分别为8.62%和26.67%,两组差异有统计学意义(P<0.05)。结论运用PMTCT模式阻断梅毒母婴传播可提高妊娠合并梅毒感染孕妇早期发现和诊断,促进妊娠梅毒的规范治疗,减少不良妊娠结局的发生率。

Knowledge Regarding Human Immunodeficiency Virus and Prevention of Mother to Child Transmission of HIV among a Group of Adults in a Low Income Country

Introduction: Despite communication on Human immunodeficiency virus (HIV), close to 5.9 million people didn’t know they were living with HIV. One of the modes of transmission of HIV is vertical transmission. It remains the principal way of transmission of HIV for children below 15 years, with over 90% of them being infected. In Cameroon, the mother and child transmission of HIV is still a problem with 5.5% of infection of exposed infant at the early infant diagnosis in 2019. Awareness on prevention of mother to child transmission (PMTCT) is an important component for the fight against HIV. We therefore aimed at gauging the level of knowledge of a group of adult clients on HIV and PMTCT. Methodology: We conducted a cross sectional and analytical study at the Yaoundé Gyneco-Obstetric and Pediatric hospital for a period of one month. Were included, adults who visited the hospital for a free screening campaign on HIV. Data were collected using a questionnaire on their characteristics and knowledge of HIV and PMTCT. Data were entered using CSPro and analysed using IBM SPSS. Results: There was a gap in knowledge on HIV, considering satisfactory knowledge from 25 points and above, it was noted that 34.6% of our respondents had a non-satisfactory knowledge. For PMTCT, knowledge was average with the majority scoring 10 points on 18. Considering satisfactory knowledge on PMTCT was from 10 and above, 35.9% of our respondents had a non-satisfactory knowledge. Female sex was associated with satisfactory knowledge for both HIV and PMTCT. Conclusion: Concerning PMTCT, the knowledge of the mode of transmission, Antiretroviral (ARV) drugs for prevention to the babies or feedings recommendations on exposed HIV infants were poor. There is a gap in favor of women regarding knowledge between HIV and PMTCT. Therefore, men are highly encouraged to take part to health promotion activities on HIV and PMTCT.

艾滋病病毒母婴传播阻断效果分析

目的分析艾滋病患病率较高的河南省某县婚龄妇女及孕妇、产妇的人类免疫缺陷病毒(HIV)感染状况;探讨实行多种干预措施后的效果及科学、简单、经济的阻断HIV经母婴传播的评价方法。方法采取整群抽样方法,对该县婚龄妇女及孕产妇进行连续4年HIV的监测,采取实验流行病学研究方法对不同目标人群采取不同干预措施(提供咨询、暂缓结婚、自愿终止妊娠、母婴抗病毒药物服用);并对HIV阳性人群进行描述性研究。对HIV感染产妇所分娩的婴儿分别进行0、9和18个月时随访与检测;初步对产妇和婴儿的药物阻断效果进行评价。结果4年来,共对婚龄妇女13 693人、孕妇32155人、产妇11367人进行HIV抗体检测;其中确认HIV阳性的婚龄妇女39人、孕妇112人、产妇81人;81名产妇所分娩的婴儿85人中,19名满18月龄婴儿HIV抗体检测阴性,其余仍在随访中。结论采用多种阻断艾滋病经母婴途径传播的干预模式,取得一定效果。

感染HIV的孕产妇预防艾滋病母婴传播服务需求与障碍分析

目的了解艾滋病病毒(HIV)感染孕产妇的预防艾滋病母婴传播服务需求与服务利用障碍。方法对某艾滋病高发地区,自2003年以来截至2004年10月发现并分娩的HIV感染孕产妇进行问卷调查。结果13.79%的孕产妇不愿意接受产前检查,5.17%的孕产妇不愿意住院分娩,怕歧视、担心检查和住院分娩费用高等是孕产妇不接受孕产期保健的主要原因;96.43%的孕产妇愿意本人和给孩子服用抗逆转录病毒药物预防艾滋病母婴传播,但只有87.50%的孕产妇服用了抗HIV药物,未服药的原因为临产急诊分娩,未得到检测结果,延误了孕产妇和婴儿的服药时机;89.29%的孕产妇希望其所生婴幼儿获得随访服务,但只有58.93%的婴幼儿得到过随访服务,其中51.52%的婴幼儿在出生后3个月内得到首次随访;怕别人知道自己的感染情况是不愿意接受随访的主要原因;近7%的孕产妇不愿意或不知道要给所生的婴幼儿进行HIV抗体检测。结论育龄妇女和孕产妇艾滋病检测不及时、非住院分娩、婴幼儿随访服务薄弱、经济负担、社会歧视等问题,是预防艾滋病母婴传播服务利用的主要障碍,预防艾滋病母婴传播综合能力亟待加强。

孕妇HIV抗体检测服务利用现状及影响因素

目的了解我国部分艾滋病高发地区孕妇对人类免疫缺陷病毒fHIv）抗体检测服务的利用情况及其影响因素。方法2005年6～7月在新疆维吾尔自治区和云南省2个艾滋病高发地区。对接受孕期保健的774名孕妇进行HIV抗体检测服务状况调查。结果2个地区孕妇HIV抗体检测率为29．33％，新疆维吾尔自治区和云南省现场孕妇HIV抗体检测率分别为34．27％，21．94％。接受过检测前咨询、配偶受教育程度较高的孕妇HIV抗体检测率高。结论我国部分艾滋病高发地区孕妇对HIV抗体检测服务利用不足，应加强检测前咨询服务提供，争取配偶参与，提高孕妇对HIV抗体检测服务的利用。

艾滋病不同流行区防治母婴传播的策略研究:基于卫生经济学评价的证据

目的通过综合分析已发表的文献,探讨低收入和中等收入国家预防艾滋病母婴传播的成本-效果、成本-效用与成本-效益。方法回顾1994年-2015年期间已发表的有关低收入和中等收入国家预防艾滋病母婴传播经济学评价的文献,分析各国的成本-效果、成本-效用和成本-效益,对其数据进行提取、整合。结果 13篇文献关注的是成本-效果,3篇文献研究的是成本-效用,9篇文献既研究了成本-效果又研究了成本-效用。结论在低、中等收入国家,预防艾滋病病毒母婴传播成本-效果最好的干预措施是孕妇自愿咨询检测(VCT)和短期口服抗逆转录病毒治疗方案(HIVNET012)/齐多夫定与抗逆转录病毒药物合用的治疗方案(ACTG076)的同时使用。成本-效用最好的干预措施是孕期抗逆转录病毒(ACTG076)和28w+HIVNET012+HIV阳性儿童的抗逆转录病毒治疗。成本-效果和成本-效用能够同时实现的干预措施是药物的使用,且最好在产后1w使用。

感染HIV的孕产妇预防艾滋病母婴传播服务利用及影响因素分析

目的了解感染艾滋病病毒(HIV)的孕产妇对预防艾滋病母婴传播(PMTCT)服务的利用状况,分析影响因素。方法在河南、广西、新疆、云南省(自治区)的15个县/市/区,对2004年1月至2006年6月检测发现的感染HIV的孕产妇346人,通过问卷调查方式,结合相关医疗记录在孕期、产时和产后分阶段完成调查。调查内容包括人口学特征、相关行为、感染途径、PMTCT服务的利用情况等。结果346名感染HIV的孕产妇中94.80%接受过产前检查,95.95%住院分娩,其希望住院分娩的原因是医院医疗技术水平高(58.28%),服务质量好(47.27%),收费低(33.33%),能够提供PMTCT服务(33.03%),保密性好(26.97%),交通方便(23.33%)等。87.57%的母婴应用抗艾滋病病毒药物,规范应用抗病毒药物者占46.82%。感染HIV的孕产妇所娩婴儿中,89.02%采取人工喂养方式,满18月龄时进行HIV检测者占93.75%。检测后咨询包含PMTCT内容、民族和文化程度对规范应用抗病毒药物有影响作用(P<0.05)。结论感染HIV的孕产妇对PMTCT服务的需求特殊,PMTCT服务利用尚不足,检测后咨询及咨询内容影响抗病毒药物的规范应用。建议加强HIV/ADIS高发地区基础妇幼保健服务,提高妊娠妇女早期和孕中期HIV抗体检测水平,重视感染HIV孕产妇抗病毒药物的规范应用和安全助产,为感染HIV的孕产妇及所娩婴儿提供个性化的、综合的PMTCT服务。

5省艾滋病高发地区HIV感染孕产妇应用抗逆转录病毒药物影响因素分析

目的了解HIV抗体咨询与检测对孕产妇应用抗逆转录病毒药物依从性的影响。方法 2006年1月至2010年12月在全国艾滋病相对高发地区的23个市/县/区开展艾滋病母婴传播队列研究。对1414名HIV感染孕产妇及所生儿童的人口学特征、应用抗逆转录病毒药物方案、孕产妇接受预防艾滋病母婴传播自愿咨询与检测服务的情况进行问卷调查。结果 1414名HIV感染孕产妇中,有1120名(79.77%)感染孕产妇接受了抗逆转录病毒药物,有87.69%儿童应用了抗逆转录病毒药物。将单因素中对用药产生影响的变量纳入多因素Logistic回归模型,结果显示,接受过检测前、后咨询服务的HIV感染孕产妇应用抗逆转录病毒药物的比例分别是未接受过检测前、后咨询者的1.99倍和3.08倍(OR=1.99,95%CI:1.37～2.89;OR=3.08,95%CI:1.16～8.20)。若HIV感染孕产妇是既往感染者,则其接受抗逆转录病毒药物的可能性较大(OR=4.11,95%CI:2.72～6.20)。结论提高HIV抗体检测咨询覆盖和服务质量,有助于提高HIV感染孕产妇对抗逆转录病毒药物的应用。

艾滋病感染孕产妇15例母婴阻断综合干预措施探讨

目的分析人类免疫缺陷病毒(HIV)阳性孕产妇感染现状,探讨艾滋病母婴阻断综合干预措施。方法对2007年4月至2013年4月芜湖市随访管理的15例艾滋病感染孕产妇个案表、孕产期检查结果、阻断用药和婴儿随访个案表进行回顾性分析。结果 15例HIV阳性孕产妇均接受母婴阻断咨询干预,选择终止妊娠6例,占40.0%;选择继续妊娠9例,占60.0%。9例婴儿存活率和人工喂养率均100.0%,其中7例满18个月艾滋病抗体检测结果为阴性,7例随访已结案的阻断成功率为100.0%;2例未满12个月仍在随访中。丈夫检测HIV阳性3例,占20.0%;阴性10例,占66.7%,未检测2例,占13.3%。孕产妇本次妊娠在医院人流、引产或分娩时受到歧视6例,占40.0%。结论外来妇女筛查、婚检和产检HIV筛查能尽早发现HIV阳性孕产妇,良好的沟通和关怀是随访管理的关键,采取孕产期综合干预措施能有效降低艾滋病母婴传播发生率。