Prevention of Mother-to-Child Transmission of HIV: Experience of a Level 2 Health Center in Senegal

The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has implemented various strategies and programs adopted and applied nationally. Thus access to services for the prevention of mother-to-child transmission of HIV has been extended to the level of the health post (the lowest level of the country’s health pyramid) with a delegation of tasks to paramedical staff (nurse, midwife) in the diagnosis and therapeutic management. Objectives: To describe the epidemiological profile of HIV (Human Immunodeficiency Virus)-positive mothers, to assess the care of children born to HIV-positive mothers, to determine the rate of HIV transmission from mother to child. Patients and Method: We carried out a retrospective, cross-sectional and descriptive study of all live newborns of HIV-positive mothers who gave birth at the Gaspard Kamara Health Center (a level 2 health center in Dakar, Senegal) between January 1, 2015 and December 31, 2018. The data were collected from prevention of mother-to-child transmission (PMTCT) prenatal follow-up registers and files, delivery files and registers, and neonatology and pediatric follow-up files, and exploited using the Epi info 7 software. Results: There were 98 children of seropositive mothers. The epidemiological profile of the HIV-positive woman was that of a young woman aged between 16 and 43 with an average of 31.31 years, pauciparous (>65% of cases) from Dakar center (>75% of cases), housewife with a low socio-economic level (63.1% of cases), married in almost all cases, with HIV profile (in almost all cases) and diagnosed before pregnancy (51.02%). The analysis of the children’s data revealed a predominance of girls (52.04%) with a good birth weight (2964g on average) and a pregnancy carried to term in more than 95% of cases. ARV prophylaxis was almost entirely respected with triple therapy (AZT + 3TC + NVP) in a fixed combination as protocol. Protected breastfeeding (80.21%), including 6 months of exclusive protected breastfeeding, was the rule for the mode of feeding. Three children were diagnosed positive with PCR1 as with serology (3.06%). Discussion and Conclusion: the initiatives and strategies put in place in Senegal have enabled a significant reduction in mother-to-child transmission of HIV and deserve to be supported by insisting on primary prevention, programming and good follow-up of pregnancies, and a good support for HIV-positive women.

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 = −0.73, p = 0.029) and level of satisfaction with PMTCT services (β = −0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = −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.

Estimating the Health and Economic Outcomes of the Prevention of Mother-to-child Transmission of HIV Using a Decision Tree Model

In 2016, there were 17.8 million (15.4-20.3 million) women living with HIV/AIDS across the world and the prevalence of reproductive desire among this group was 26%-49%[1]. If pregnant women living with HIV/AIDS are left untreated, the rates of HIV transmission from mother-to-child would range from 14% to 48%, depending on the presence and duration of breastfeeding[2].

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.

Beliefs and practices of young women on utilization of prevention of mother to child transmission of HIV services in Malawi

This study explored beliefs and actual practices of young women on utilization of Prevention of Mother to Child Transmission (PMTCT) of HIV services in Balaka district of Southern Malawi. The study design wascross sectional which utilized qualitative data collection and analysis methods. In-depth interviews were conducted on 12 young mothers of 15 to 24 years old. The respondents were drawn from 6 health centres in the district during their visits to either the under-five clinic, HIV and AIDS support groups or HIV follow up clinics. Data were analyzed using thematic analysis approach. Overall the respondents had positive beliefs on utilization of PMTCT services. They believed that adherence to PMTCT guidelines such as condom use, taking of Nevirapine (NVP) and exclusive breastfeeding protected the baby from contracting the virus. Nevertheless, all respondents believed that HIV testing was mandatory and that early weaning caused malnutrition and death of babies. Actual practice was very low. Very few young mothers breastfed exclusively, weaned their babies abruptly and took NVP as recommended. Not all positive beliefs translated into positive behavior. Lack of male support, inability of the midwives to provide comprehensive care to HIV infected mothers and their infants, and fear of stigma and discrimination were other factors that hindered utilization of PMTCT services. Culture was also a major barrier because traditionally babies are expected to be breastfed and supplements are fed to babies too. Therefore, there is a need to mobilize communities on PMTCT of HIV. Education programmes in HIV should emphasize behavior change interventions and should focus on both men and women and significant others. There is also need to intensify monitoring and evaluation of health workers’ activities to ensure that beliefs translate into positive behavior.

Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-Child Transmission of Hepatitis B Virus(Version 2024)

The Chinese Clinical Practice Guidelines for the prevention and treatment ofmother-to-child transmission of hepatitis B virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019,serves as a valuable reference for standardizing the process of preventing mother-to-child transmission in China.As new evidence emerges,it is crucial that timely and regular updates are made to the clinical practice guidelines so as to optimize guidance for clinical practice and research.To this end,the Infectious Disease Physician Branch of Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of Chinese Medical Association,in collaboration with multidisciplinary experts,have updated the guidelines based on the latest domestic and international research advancements and clinical practice,in order to provide guidance and reference for clinicians andmaternal and child healthcare workers.

Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus(Version 2024)

The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019,serves as a valuable reference for standardizing the prevention of mother-to-child transmission in China.As new evidence continues to emerge,it is essential to update these guidelines regularly to optimize clinical practice and research.To this end,the Infectious Disease Physician Branch of the Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of the Chinese Medical Association,in collaboration with multidisciplinary experts,have updated the guidelines based on the latest domestic and international research advancements and clinical practices,providing upto-date guidance for clinicians and maternal and child healthcare workers.

Strategies to Prevent Mother-to-child Transmission of Hepatitis B Virus

Mother-to-child transmission(MTCT)of hepatitis B virus(HBV)is the primary cause of chronic HBV infection worldwide.MTCT prevention and antiviral treatment of infected individuals could eliminate this public health burden.Antiviral treatment of hepatitis B surface antigen(HBsAg)-positive pregnant women and immunoprophylaxis with HBV vaccine and hepatitis B immune globulin are the most effective strategies to interfere with MTCT of HBV.However,for worldwide application of those strategies,feasibility,availability,cost,safety,and effectiveness should be considered.Cesarean section and breastfeeding avoidance in hepatitis B e antigenpositive mothers with a high viral load and without antiviral therapy during pregnancy could be an option,but more supporting evidence is needed.HBsAg screening of all pregnant women is recommended when initiating antiviral therapy and immunoprophylaxis for MTCT prevention,except in areas with limited resources.Timely HBV vaccination series administered soon after birth might be the mainstay of prevention.This review aimed to provide a concise update on the effectiveness of available strategies to prevent MTCT of HBV.

2019 Chinese Clinical Practice Guidelines for the Prevention of Mother-to-child Transmission of Hepatitis B Virus

To develop the evidence-based guidelines for managing mother-to-child transmission of hepatitis B virus in China, a multidisciplinary guideline development group was estab-lished. Clinical questions were identified from two rounds of surveys on the concerns of first-line clinicians. We conducted a comprehensive search and review of the literature. A grading of recommendations' assessment, development, and evaluation system was adopted to rate the quality of evidence and the strength of recommendations. Recommen-dations were formulated based on the evidence, overall balance of benefits and harms (at individual and population levels), patient/health worker values and preferences, re-sources available, cost-effectiveness, and feasibility. Even-tually, recommendations related to 13 main clinical concerns were developed, covering diagnostic criteria, treatment in-dications, antiviral therapy choice, timing to initiate and discontinue treatment, immunoprophylaxis strategy at birth, and how to deal with special situations, such as unintended pregnancy, assisted reproduction, and breastfeeding. The guidelines are intended to serve as guidance for clinicians and patients, to optimize the management of majority of pregnant women who are positive for hepatitis B surface antigen. Guideline registration: International Practice Guide Registration Platform (IPGRP-2018CN040).

A Mother-to-Child Transmission Study in Nigeria:The Impact of Maternal HIV Infection and HAART on Plasma Immunoglobulins,Cytokine Profiles and Infant Outcome

Prevention of mother-to-child transmission(PMTCT)of HIV with highly active antiretroviral therapy(HARRT)allows the HIV^+pregnant mothers to have vaginal delivery and breastfeed.Here we investigated the maternal plasma immunoglobulin,cytokine secretion and the outcome of the exposed infants among the HIV^+HAART treated pregnan women in Nigeria.In this study,different plasma immunoglobulins and cytokines were measured in the HIV^+HAART treated pregnant mothers.Pooled culture supernatants of B and T lymphocytes showed lower levels of IFN-γ,IL-10 and IL-4.There were lower IFN-γand IL-10 secretions at 1st trimester;however,IL-10 continued to be lower throughout 2nd and 3rd trimesters.TNF-αsecretion significantly decreased as pregnancy progressed to term.There were high plasma IgG and low IgM in the HIV^+HAART treated pregnant women.Plasma IgG was high during 1st and 3rd trimesters.After one year of follow up,all the exposed children were seronegative for HIV-1 and HIV-2.Vaginal delivery and breastfeeding among HIV^+HAART treated mothers have shown to be safe.The use of HAART by the infected mothers and the use of septrin and niverapin by the exposed infants prevented mother to-child transmission of HIV.

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。

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。

HIV母婴传播阻断综合措施与效果评价

目的分析妊娠合并人类免疫缺陷病毒(HIV)感染孕产妇实行综合性母婴阻断措施的效果。方法回顾性分析北京地坛医院2003年至2017年81例合并HIV感染的孕产妇实行综合性阻断措施后,新生儿感染HIV的情况。结果经过艾滋病母婴传播阻断综合干预后,81例孕产妇中有10例在知情同意后选择终止妊娠,纳入母婴阻断服药的人数为71例。71例合并HIV感染的孕产妇中,流产7例次,生产65例次,65例新生儿均进行了新生儿药物阻断,阻断成功率为100.0%。结论对HIV感染的孕产妇进行综合性母婴传播阻断措施,可以很大程度上降低HIV的母婴传播率,控制新生儿艾滋病流行。

凉山地区预防艾滋病母婴传播相关资源整合的分析

目的通过收集四川省凉山地区与预防艾滋病母婴传播相关的妇女保健和儿童保健各环节上现有资源的投入和支持，探索凉山地区整合相关卫生资源促进预防艾滋病母婴传播工作开展的可行性和有效性。方法通过定量调查的方法了解艾滋病感染孕产妇分娩所需费用，通过深入访谈和小组讨论等定性方法，获取目前预防艾滋病母婴传播工作资金和其他相关卫生资源的投入等信息，以及整合与利用情况。结果目前凉山地区预防艾滋病母婴传播的经费支持来源于中央财政转移支付和默沙东艾滋病防治项目。与预防艾滋病母婴传播有关的支持分别来自新型农村合作医疗、降低孕产妇死亡率和消除新生儿破伤风项目、农村孕产妇住院分娩补助、民政医疗救助等项目。某县艾滋病感染孕产妇住院分娩的费用57．12％来源于预防艾滋病母婴传播项目，新农合占34．21％，降消项目占5．22％，个人负担3．45％。结论预防艾滋病母婴传播项目以及妇幼卫生相关项目和政策均对孕产妇艾滋病检测及住院分娩予以经费支持；而其他与预防艾滋病母婴传播相关的服务环节，如婚前保健、孕期保健、产褥期保健、儿童保健等服务得到支持和关注较少。建议在凉山的贫困边远和少数民族地区合理调配现有资源，关注和强调孕期保健、儿童保健，加大对发现孕产妇、艾滋病感染儿童的随访和指导服务中人力和物力的投入。

我国部分地区孕妇艾滋病知识知晓状况

目的了解我国部分艾滋病高发地区一般孕妇关于艾滋病及预防艾滋病母婴传播相关知识知晓程度，并对其影响因素进行分析。方法2005年5—7月在两个艾滋病高发地区对接受孕期保健的774名孕妇进行艾滋病相关知识知晓情况调查。结果①两个地区的孕妇对艾滋病一般知识知晓率最高达到59．69％，母婴传播相关知识知晓率最高仅有21．18％；②受教育程度高、初孕、有过婚前性行为的孕妇对艾滋病母婴传播相关知识知晓率较高；③受教育程度高（OR=2．05，95％CI=1．69～2．51，P〈0．01）、能够接受婚前性行为、愿意与艾滋病感染者交往（OR=4．65，95％CI=3．21—6．71，P〈0．01）、接受过艾滋病病毒抗体检测（OR=2．00，95％CI=1．33—2．97，P〈0．01）、到外地打过工等因素可能提高孕妇对艾滋病一般知识知晓率。结论我国部分艾滋病高发地区孕妇人群对艾滋病相关知识知晓率较低，艾滋病母婴传播相关知识十分薄弱，应加强预防艾滋病母婴传播的健康教育，以提高孕妇人群对艾滋病相关知识知晓率。

HIV抗体阳性孕产妇母婴阻断措施实施情况分析

目的了解商丘市预防艾滋病病毒母婴传播措施的实施情况及母婴阻断效果,探讨预防艾滋病病毒母婴传播对策。方法对2005-06/2007-07发现的48例HIV抗体阳性孕产妇进行问卷调查及随访,收集其妊娠结局、抗病毒药物服用情况、分娩方式、婴儿喂养方式、婴儿HIV感染情况等资料并进行分析。结果23例孕妇实施人工流产,2例自然流产,4例处于妊娠期,19例已分娩。分娩的产妇有84.2%规律服用过抗病毒药物,47.4%采用了剖宫产;19例新生儿中,89.5%规律服用过抗病毒药物,94.7%采用人工喂养。10例婴儿在满18月龄时检测HIV抗体为阴性。结论现行的预防艾滋病母婴传播措施是可行的。完善妇幼保健服务网络,提高孕期保健率,促进孕产妇HIV咨询检测工作,及时发现HIV感染孕产妇以及加强对阳性育龄妇女的随访是深化母婴阻断工作的重要途径。

孕产妇获取艾滋病自愿咨询检测服务效果评估

目的评估促进妊娠妇女获取艾滋病自愿咨询检测服务的效果,为更有效地开展预防艾滋病母婴传播工作提供科学依据。方法选择条件类似的两个乡镇作为干预地区(干预组)和对照地区(对照组),开展促进妊娠妇女获取艾滋病自愿咨询检测服务的干预研究,评价干预的效果。结果共完成对1701名妊娠妇女的调查,其中干预组923人,对照组778人。干预前两组预防艾滋病母婴传播知识政策的知晓率和获取自愿咨询检测服务比较差异无统计学意义(P>0.05);实施干预后,干预组预防艾滋病母婴传播知识政策的知晓率高于对照组(2χ=26.90,P<0.001),干预后知晓率的提高促进了行为的改变,干预组比对照组的艾滋病毒抗体检测率和孕28周前检测率均有提高(2χ分别为14.02、261.75,均P<0.001)。结论建立以社区为基础的促进妊娠妇女艾滋病自愿咨询检测获取服务模式,明显提高了妊娠妇女的预防艾滋病母婴传播知识政策知晓率、总艾滋病抗体检测覆盖率和孕28周前艾滋病抗体检测覆盖率,对避免艾滋病母婴传播起到了积极的作用,经验值得推广。

2015年安徽省先天梅毒直报系统病例核查结果分析

目的:明确2015年安徽省传染病直报系统和母婴阻断直报系统中报告的先天梅毒人数的准确性。方法:下载传染病和母婴阻断直报系统中先天性梅毒报告人数最多的5个市的患者资料,进行核查。结果:纠正重报和漏报后传染病直报系统应报194例,符合先天梅毒4例(2.1%)、非先天梅毒8例(4.1%),疑似先天梅毒182例(93.8%)。母婴阻断直报系统报告1例,为确诊病例。结论:母婴阻断信息系统上报的先天梅毒人数太少,而传染病信息系统上报的先天梅毒多为疑似病例,两个系统的报告例数均不宜直接用于计算先天梅毒发病率。

凉山彝族聚居区艾滋病母婴传播干预影响因素定性研究

目的了解四川省凉山彝族聚居区艾滋病母婴传播干预实施的影响因素。方法采用个人深入访谈的定性研究方法,围绕影响当地艾滋病母婴传播控制工作实施的影响因素,对凉山州某彝族聚居县妇幼卫生工作负责人、妇产科医务人员、村妇幼保健员、村医生、HIV阳性妇女和HⅣ阴性育龄妇女进行访谈。结果研究共对101名调查对象开展个人深入访谈,影响当地艾滋病母婴传播干预的因素主要包括交通不便、阳性孕产妇家庭经济困难和育龄妇女自身对艾滋病母婴传播危害认识不足等8个方面,其中超生与新农合报销之间的矛盾、喂养卫生问题为相对特殊的原因。结论应加强乡镇卫生院妇幼卫生资源配置,增强服务可及性,对阳性孕妇家庭开展特殊医疗补助,加强艾滋病母婴传播危害宣传。

婴儿乙型肝炎疫苗免疫效果评价

目的评价婴儿接种乙型肝炎疫苗的效果。方法回顾性分析2002-2012年北京市顺义区母亲为乙肝表面抗原(HBsAg)阳性和母亲为HBsAg阴性的婴儿(普通婴儿)接种乙肝疫苗后的血清学资料。结果 224例母亲为HBsAg阳性的婴儿中,HBsAg阳性者5例,阳性率为2.2%;HBsAb阳性者204例。219例HBsAg阴性婴儿和165例普通婴儿的HBsAb阳性率分别为93.2%和99.4%。母亲HBsAg、HBeAg双阳性者、母亲单阳性者(HBsAg阳性)及母亲HBsAg阳性、HBsAg不详者,3组的免疫效果差异无统计学意义(P>0.05)。母亲HBsAg阳性婴儿免疫效果比普通婴儿差(P<0.01)。母亲为HBsAg阳性的婴儿接种10μg剂量进口疫苗和10μg剂量"搭配接种方案"的免疫效果均优于5μg国产疫苗(P<0.05)。母亲HBsAg阳性是阻碍婴儿HBsAb产生的影响因素(OR=0.086,P=0.035)。结论顺义区现行乙肝免疫策略对母亲为HBsAg阳性的婴儿免疫效果较理想,但较普通婴儿效果略差。