广西部分艾滋病高流行区人类免疫缺陷病毒母婴阻断效果及及时性、依从性研究
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摘要
目的系统评价广西部分高流行区人类免疫缺陷病毒(human immunodeficiency virus,HIV)母婴阻断效果及及时性、依从性,探讨相关影响因素。方法 2011年1月至2017年9月,采取非概率整群抽样和随访观察研究,对广西部分艾滋病高流行区内319例调查对象进行母婴阻断干预,从传播率、及时性和依从性等方面了解HIV母婴阻断效果,采用Logistic回归模型分析接受干预及时性和依从性的相关影响因素。结果继续妊娠HIV感染孕产妇用药率为95.92%(306/319);安全分娩率70.51%(225/319),呈逐年升高趋势(Z=2.03,P=0.042),累计分娩活婴295例;儿童用药率98.31%(290/295),人工喂养率98.64%(291/295),早期诊断率96.20%(152/158),18月龄抗体检测率93.90%(277/295),随访率97.97%(289/295),死亡率1.69%(5/295),失访率4.1%(12/295)。HIV母婴传播率1.06%(校正1.92%)。HIV母婴阻断及时性好率54.86%(175/319),其影响因素包括稳定住址、妊娠意愿、确认时间、艾滋病认知、配偶支持和焦虑情绪。HIV母婴阻断依从性好率52.04%(162/319),其影响因素包括文化程度、稳定住址、产前保健次数、病毒载量、CD4水平、艾滋病认知、配偶支持和焦虑情绪。结论广西贵港市等部分艾滋病高流行区HIV母婴阻断成功率比较高,但母婴阻断及时性及依从性差,服务利用质量有待提高。
Objective To systematically evaluate the effect of the interventions for preventing motherto-child HIV transmission and explore the factors affecting the timeliness of these interventions and the patient compliance in regions with a high HIV/AIDS prevalence in Guangxi Zhuang Autonomous Region. Methods Between January,2011 and September,2017,using a non-probability cluster sampling method with follow-up observation,we conducted interventions for preventing mother-to-child HIV transmission in 319 HIV-infected pregnant women in some regions with a high HIV/AIDS prevalence in Guangxi Zhuang Autonomous Region.The transmission rate,timeliness of administration and compliance with the interventions were assessed to evaluate the effect of these interventions,and a logistic regression model was used to analyze the factors influencing the timeliness of the interventions and the patient compliance. Results The rate of antiviral drug administration was 95. 92%(306/319) in these HIV-infected pregnant women who chose to continue pregnancy. The overall safe delivery rate was 70. 51%(225/319),and the annual safe delivery rate tended to increase with time(Z = 2. 03,P = 0. 042). A total of 295 live births were recorded,and 98. 31%(290/295) of the children were given antiviral drugs; the artificial feeding rate was 98. 64%(291/295) in these children; 96. 20%(152/158) of the children received services for early diagnosis and 93. 90%(277/295)were detected for HIV antibody at 18 month. The follow-up rate of the children was 97. 97%(289/295),with a mortality rate of 1. 69%(5/295) and a loss to follow-up rate of 4. 1%(12/295). The mother-to-child HIV transmission rate was 1. 06%(1. 92% after correction) in these cases. The rate of optimal timing of the transmission-preventing interventions was 54. 86%(175/319),and the factors influencing the timeliness of the interventions included stability of address,pregnancy intention,confirmation time,AIDS awareness,spouse support and anxiety. The good compliance rate with the interventions was 52. 04%(162/319),and was influenced by the factors including the level of education,stability of address,frequency of antenatal care,viral load,CD4 level,AIDS awareness,spouse support and anxiety. Conclusion In these selected regions with a high HIV/AIDS prevalence,the interventions for preventing mother-to-child HIV transmission resulted in a relatively high success rate,but the timeliness of administration and compliance with these interventions,along with the quality of service utilization,remain to be improved.
Objective To systematically evaluate the effect of the interventions for preventing motherto-child HIV transmission and explore the factors affecting the timeliness of these interventions and the patient compliance in regions with a high HIV/AIDS prevalence in Guangxi Zhuang Autonomous Region. Methods Between January,2011 and September,2017,using a non-probability cluster sampling method with follow-up observation,we conducted interventions for preventing mother-to-child HIV transmission in 319 HIV-infected pregnant women in some regions with a high HIV/AIDS prevalence in Guangxi Zhuang Autonomous Region.The transmission rate,timeliness of administration and compliance with the interventions were assessed to evaluate the effect of these interventions,and a logistic regression model was used to analyze the factors influencing the timeliness of the interventions and the patient compliance. Results The rate of antiviral drug administration was 95. 92%(306/319) in these HIV-infected pregnant women who chose to continue pregnancy. The overall safe delivery rate was 70. 51%(225/319),and the annual safe delivery rate tended to increase with time(Z = 2. 03,P = 0. 042). A total of 295 live births were recorded,and 98. 31%(290/295) of the children were given antiviral drugs; the artificial feeding rate was 98. 64%(291/295) in these children; 96. 20%(152/158) of the children received services for early diagnosis and 93. 90%(277/295)were detected for HIV antibody at 18 month. The follow-up rate of the children was 97. 97%(289/295),with a mortality rate of 1. 69%(5/295) and a loss to follow-up rate of 4. 1%(12/295). The mother-to-child HIV transmission rate was 1. 06%(1. 92% after correction) in these cases. The rate of optimal timing of the transmission-preventing interventions was 54. 86%(175/319),and the factors influencing the timeliness of the interventions included stability of address,pregnancy intention,confirmation time,AIDS awareness,spouse support and anxiety. The good compliance rate with the interventions was 52. 04%(162/319),and was influenced by the factors including the level of education,stability of address,frequency of antenatal care,viral load,CD4 level,AIDS awareness,spouse support and anxiety. Conclusion In these selected regions with a high HIV/AIDS prevalence,the interventions for preventing mother-to-child HIV transmission resulted in a relatively high success rate,but the timeliness of administration and compliance with these interventions,along with the quality of service utilization,remain to be improved.
引文
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[9]高洁,王映霞,吴颖岚,等.湖南省2010-2013年预防艾滋病母婴传播情况分析[J].实用预防医学,2015,22(7):778-780.DOI:10.3969/j.issn.1006-3110.2015.07.003.GAO J,WANG Y X,WU Y L,et al.Analysis on prevention of mother-to-child transmission of HIV(PMTCT)work in hunan province in 2010-2013[J].Prac Prev Med,2015,22(7):778-780.DOI:10.3969/j.issn.1006-3110.2015.07.003.
[10]单多,王娟,孙江平,等.云南省德宏州2011-2013年预防艾滋病、梅毒和乙型肝炎母婴传播效果研究[J].中华预防医学杂志,2014,48(11):942-946.DOI:10.3760/cma.j.issn.0253-9624.2014.11.005.SHAN D,WANG J,SUN J P,et al.A study on the effectiveness of prevention of mother-to-child HIV,syphilis,and hepatitis B transmission among pregnant women in Dehong prefecture,Yunnan province,China from 2011 to 2013[J].Chin J Prev Med,2014,48(11):942-946.DOI:10.3760/cma.j.issn.0253-9624.2014.11.005.
[11]SIDIB M,SINGH P K.Thailand eliminates mother-to-child transmission of HIV and syphilis[J].Lancet,2016,387(10037):2488-2489.DOI:10.1016/S0140-6736(16)30787-5.
[12]WAND H,RAMJEE G.Identifying factors associated with low-adherence and subsequent HIV seroconversions among South African women enrolled in a biomedical intervention trial[J].AIDS Behavior,2017,21(2):393-401.DOI:10.1007/s10461-016-1471-1.
[13]SOVANNARITH S,SOKLENG S,ROMAING T,et al.Uptake of interventions for preventing mother-to-child HIV transmission in 11 operational districts in Cambodia[J].Western Pac Surveill Response J,2012,3(3):22-28.DOI:10.5365/WPSAR.2012.3.2.009.
[14]汤后林,许娟,韩晶,等.2010-2014年中国新报告HIV感染者和艾滋病患者抗病毒治疗及时性及影响因素分析[J].中华预防医学杂志,2017,51(8):711-717.DOI:10.3760/cma.j.issn.0253-9624.2017.08.010.TANG H L,XU J,HAN J,et al.An analysis of factors associated with timeliness of antiretroviral therapy initiation among newly diagnosed HIV/AIDS from 2010 to 2014 in China[J].Chin J Prev Med,2017,51(8):711-717.DOI:10.3760/cma.j.issn.0253-9624.2017.08.010.
[15]AUERBACH J D,KINSKY S,BROWN G,et al.Knowledge,attitudes,and likelihood of pre-exposure prophylaxis(Pr EP)use among US women at risk of acquiring HIV[J].AIDS Patient Care STDS,2015,29(2):102-110.DOI:10.1089/apc.2014.0142.
[16]PARK J,NACHMAN S.The link between religion and HAART adherence in pediatric HIV patients[J].AIDS Care,2010,22(5):556-561.DOI:10.1080/09540120903254013.
[17]SHETH S S,COLEMAN J,CANNON T,et al.Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV[J].AIDS Care,2015,27(3):350-354.DOI:10.1080/09540121.2014.998610.
[18]GLASHEEN C,COLPE L,HOFFMAN V,et al.Prevalence of serious psychological distress and mental health treatment in a national sample of pregnant and postpartum women[J].Matern Child Health J,2015,19(1):204-216.DOI:10.1007/s10995-014-1511-2.
[19]SCHNACK A,REMPIS E,DECKER S,et al.Prevention of mother-to-child transmission of HIV in option B+era:uptake and adherence during pregnancy in western uganda[J].AIDS Patient Care STDs,2016,30(3):110-118.DOI:10.1089/apc.2015.0318.
[20]TREISMAN K,JONES F W,SHAW E.The experiences and coping strategies of united kingdom-based african women following an HIV diagnosis during pregnancy[J].J Assoc Nurses AIDS Care,2014,25(2):145-157.DOI:10.1016/j.jana.2013.01.008.
[21]MATTHEWS L T,RIBAUDO H B,KAIDA A,et al.HIV-infected ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception,pregnancy,and postpartum periods[J].J Acquir Immune Defic Syndr,2016,71(4):399-406.DOI:10.1097/QAI.0000000000000874.
[2]SIDIBM,SINGH P K.Thailand eliminates mother-to-child transmission of HIV and syphilis[J].Lancet,2016,387(10037):2488-2489.DOI:10.1016/S0140-6736(16)30787-5.
[3]赵文宇,俞海亮,叶少东,等.中国三省386例HIV感染者和艾滋病患者抗病毒治疗服药依从性及其影响因素分析[J].中华预防医学杂志,2016,50(4):334-338.DOI:10.3760/cma.j.issn.0253-9624.2016.04.010.ZHAO W Y,YU H L,YE S D,et al.Factors associated with adherence of highly active antiretroviral therapy among386 HIV/AIDS patients in 3 provinces of China[J].Chin J Prev Med,2016,50(4):334-338.DOI:10.3760/cma.j.issn.0253-9624.2016.04.010.
[4]代容,冯婧,唐茂芝,等.中国2004-2010年艾滋病母婴传播率及母婴阻断药物应用状况的系统评价[J].第二军医大学学报,2014,35(10):1094-1102.DOI:10.3724/SP.J.1008.2014.01094.DAI R,FENG J,TANG M Z,et al.Mother-to-child transmission rate of HIV and use of drugs to prevent the transmission in China:a systematic review[J].Acad J Sec Mil Med Univ,2014,35(10):1094-1102.DOI:10.3724/SP.J.1008.2014.01094.
[5]ZOU H,DAI X,MENG X,et al.HIV/AIDS-related knowledge,attitudes,and sexual practices among migrant wives in rural Anhui province,China[J].J AIDS Clin Res,2014,5(7):319-324.DOI:10.4172/2155-6113.1000319.
[6]WANG A L,QIAO Y P,WANG L H,et al.Integrated prevention of mother-to-child transmission for human immunodeficiency virus,syphilis and hepatitis B virus in China[J].Bull World Health Organ,2015,93(1):52-56.DOI:10.2471/BLT.14.139626.
[7]DINH T H,DELANEY K P,GOGA A,et al.Impact of maternal HIV seroconversion during pregnancy on early mother to child transmission of HIV(MTCT)measured at 4-8 weeks postpartum in South Africa 2011–2012:A National Population-Based Evaluation[J].PLo S ONE,2015,10(5):e0125525.DOI:10.1371/journal.pone.0125525.
[8]RUTON H,MUGWANEZA P,SHEMA N,et al.HIV-free survival among nine-to 24-month-old children born to HIVpositive mothers in the Rwandan national PMTCT programme:a community-based household survey[J].J Int AIDS Soc,2012,15(1):1-17.DOI:10.1186/1758-2652-15-4.
[9]高洁,王映霞,吴颖岚,等.湖南省2010-2013年预防艾滋病母婴传播情况分析[J].实用预防医学,2015,22(7):778-780.DOI:10.3969/j.issn.1006-3110.2015.07.003.GAO J,WANG Y X,WU Y L,et al.Analysis on prevention of mother-to-child transmission of HIV(PMTCT)work in hunan province in 2010-2013[J].Prac Prev Med,2015,22(7):778-780.DOI:10.3969/j.issn.1006-3110.2015.07.003.
[10]单多,王娟,孙江平,等.云南省德宏州2011-2013年预防艾滋病、梅毒和乙型肝炎母婴传播效果研究[J].中华预防医学杂志,2014,48(11):942-946.DOI:10.3760/cma.j.issn.0253-9624.2014.11.005.SHAN D,WANG J,SUN J P,et al.A study on the effectiveness of prevention of mother-to-child HIV,syphilis,and hepatitis B transmission among pregnant women in Dehong prefecture,Yunnan province,China from 2011 to 2013[J].Chin J Prev Med,2014,48(11):942-946.DOI:10.3760/cma.j.issn.0253-9624.2014.11.005.
[11]SIDIB M,SINGH P K.Thailand eliminates mother-to-child transmission of HIV and syphilis[J].Lancet,2016,387(10037):2488-2489.DOI:10.1016/S0140-6736(16)30787-5.
[12]WAND H,RAMJEE G.Identifying factors associated with low-adherence and subsequent HIV seroconversions among South African women enrolled in a biomedical intervention trial[J].AIDS Behavior,2017,21(2):393-401.DOI:10.1007/s10461-016-1471-1.
[13]SOVANNARITH S,SOKLENG S,ROMAING T,et al.Uptake of interventions for preventing mother-to-child HIV transmission in 11 operational districts in Cambodia[J].Western Pac Surveill Response J,2012,3(3):22-28.DOI:10.5365/WPSAR.2012.3.2.009.
[14]汤后林,许娟,韩晶,等.2010-2014年中国新报告HIV感染者和艾滋病患者抗病毒治疗及时性及影响因素分析[J].中华预防医学杂志,2017,51(8):711-717.DOI:10.3760/cma.j.issn.0253-9624.2017.08.010.TANG H L,XU J,HAN J,et al.An analysis of factors associated with timeliness of antiretroviral therapy initiation among newly diagnosed HIV/AIDS from 2010 to 2014 in China[J].Chin J Prev Med,2017,51(8):711-717.DOI:10.3760/cma.j.issn.0253-9624.2017.08.010.
[15]AUERBACH J D,KINSKY S,BROWN G,et al.Knowledge,attitudes,and likelihood of pre-exposure prophylaxis(Pr EP)use among US women at risk of acquiring HIV[J].AIDS Patient Care STDS,2015,29(2):102-110.DOI:10.1089/apc.2014.0142.
[16]PARK J,NACHMAN S.The link between religion and HAART adherence in pediatric HIV patients[J].AIDS Care,2010,22(5):556-561.DOI:10.1080/09540120903254013.
[17]SHETH S S,COLEMAN J,CANNON T,et al.Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV[J].AIDS Care,2015,27(3):350-354.DOI:10.1080/09540121.2014.998610.
[18]GLASHEEN C,COLPE L,HOFFMAN V,et al.Prevalence of serious psychological distress and mental health treatment in a national sample of pregnant and postpartum women[J].Matern Child Health J,2015,19(1):204-216.DOI:10.1007/s10995-014-1511-2.
[19]SCHNACK A,REMPIS E,DECKER S,et al.Prevention of mother-to-child transmission of HIV in option B+era:uptake and adherence during pregnancy in western uganda[J].AIDS Patient Care STDs,2016,30(3):110-118.DOI:10.1089/apc.2015.0318.
[20]TREISMAN K,JONES F W,SHAW E.The experiences and coping strategies of united kingdom-based african women following an HIV diagnosis during pregnancy[J].J Assoc Nurses AIDS Care,2014,25(2):145-157.DOI:10.1016/j.jana.2013.01.008.
[21]MATTHEWS L T,RIBAUDO H B,KAIDA A,et al.HIV-infected ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception,pregnancy,and postpartum periods[J].J Acquir Immune Defic Syndr,2016,71(4):399-406.DOI:10.1097/QAI.0000000000000874.