广东省HIV感染产妇孕期使用抗艾滋病病毒药物的影响因素
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摘要
目的分析广东省人类免疫缺陷病毒(HIV)感染产妇孕期使用抗艾滋病病毒药物预防母婴传播的影响因素,为改进相应工作提供依据。方法对广东省项目登记的2007年1月-2015年6月活产分娩的1 365例HIV感染产妇及其新生儿调查数据进行多因素Logistic回归分析。结果有50.26%(686/1 365)的HIV感染产妇在孕期使用了抗艾滋病病毒药物。孕次多(OR=0.794)、孕期确认HIV感染(OR=0.277)、配偶或性伴HIV感染(OR=0.644)、择期剖宫产(OR=0.314)、孕期随访次数多(1~2次OR=0.205、3~5次OR=0.115、>5次OR=0.085)、孕期检测过乙肝抗体(OR=0.307)、丈夫嫖娼(OR=0.143)、新生儿低出生体质量(OR=0.355)的服药比例较高;产时确认HIV感染(OR=9.912)、艾滋病检测后无咨询(OR=4.276)、丈夫未检测HIV或状态不详(OR=3.063、OR=2.302)、初次产检孕周>28周(OR=2.867)、出生孕周较大(33~36周OR=11.090、37~40周OR=10.912、41~42周OR=22.872)的不服药风险较高。结论较高的孕产期保健依从性、及时随访和咨询、较好的经济条件、丈夫参与度高可有效提高HIV感染产妇孕期抗艾滋病病毒药物的使用率。
Objective To analyze the influencing factors of effect of use of anti-HIV drugs during pregnancy in prevention of AIDS mother-to-child-transmission among HIV-infected mothers in Guangdong,provide a basis for improving corresponding work. Methods A multivariate logistic regression model was used to analyze the investigation data of neonates born by 1 365 HIV-infected mothers in Guangdong from January 2007 to June 2015. Results Among 1 365 HIV-infected mothers,686 cases( 50. 26%) used anti-HIV drugs during pregnancy. The application rates of anti-HIV drugs were high among the HIV-infected mothers with more gravida( OR = 0. 794),confirmed HIV infection during pregnancy( OR = 0. 277),HIV infection of spouse/sex partner( OR = 0. 644),selective caesarean section( OR =0. 314),more follow-up times during pregnancy( 1-2 times: OR = 0. 205; 3-5 times: OR = 0. 115; >5 times: OR = 0. 085),HBV antibody detection during pregnancy( OR = 0. 307),commercial sex behavior of husband( OR = 0. 143),neonatal low birth weight( OR =0. 355). The risks of no medication were high among the mothers with confirmed intrapartum HIV infection( OR = 9. 912),no consultation after HIV detection( OR = 4. 276),lack or unknown status of HIV detection of husband( OR = 3. 063,OR = 2. 302),undergoing prenatal examination for the first time>28 gestational weeks( OR = 2. 867),high gestational weeks( 33-36 weeks: OR = 11. 090; 37-40 weeks:OR = 10. 912; 41-42 weeks: OR = 22. 872). Conclusion High compliance of antenatal care,timely follow-up and consultation,good economic status,and more husband participation can effectively increase the use rate of anti-HIV drugs during pregnancy among HIV-infected mothers.
Objective To analyze the influencing factors of effect of use of anti-HIV drugs during pregnancy in prevention of AIDS mother-to-child-transmission among HIV-infected mothers in Guangdong,provide a basis for improving corresponding work. Methods A multivariate logistic regression model was used to analyze the investigation data of neonates born by 1 365 HIV-infected mothers in Guangdong from January 2007 to June 2015. Results Among 1 365 HIV-infected mothers,686 cases( 50. 26%) used anti-HIV drugs during pregnancy. The application rates of anti-HIV drugs were high among the HIV-infected mothers with more gravida( OR = 0. 794),confirmed HIV infection during pregnancy( OR = 0. 277),HIV infection of spouse/sex partner( OR = 0. 644),selective caesarean section( OR =0. 314),more follow-up times during pregnancy( 1-2 times: OR = 0. 205; 3-5 times: OR = 0. 115; >5 times: OR = 0. 085),HBV antibody detection during pregnancy( OR = 0. 307),commercial sex behavior of husband( OR = 0. 143),neonatal low birth weight( OR =0. 355). The risks of no medication were high among the mothers with confirmed intrapartum HIV infection( OR = 9. 912),no consultation after HIV detection( OR = 4. 276),lack or unknown status of HIV detection of husband( OR = 3. 063,OR = 2. 302),undergoing prenatal examination for the first time>28 gestational weeks( OR = 2. 867),high gestational weeks( 33-36 weeks: OR = 11. 090; 37-40 weeks:OR = 10. 912; 41-42 weeks: OR = 22. 872). Conclusion High compliance of antenatal care,timely follow-up and consultation,good economic status,and more husband participation can effectively increase the use rate of anti-HIV drugs during pregnancy among HIV-infected mothers.
引文
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[13]Nlend AEN,MotazéAN,Tetang SM,et al.Preterm birth and low birth weight after in utero exposure to antiretrovirals initiated during pregnancy in Yaoundé,Cameroon[J].PLo S One,2016,11(3):e0150565.
[14]Woldesenbet S,Jackson D,Lombard C,et al.Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa:uptake,determinants,and attributable risk(the SAPMTCTE)[J].PLo S One,2015,10(7):e0132425.
[15]Colombini M1,Stockl H,Watts C,et al.Factors affecting adherence to short-course ARV prophylaxis for preventing mother-tochild transmission of HIV in sub-Saharan Africa:a review and lessons for future elimination[J].AIDS Care,2014,26(7):914-926.
[16]Aizire J,Fowler MG,Coovadia HM.Operational issues and barriers to implementation of prevention of mother-to-child transmission of HIV(PMTCT)interventions in Sub-Saharan Africa[J].Curr HIV Res,2013,11(2):144-159.
[17]Watts DH,Williams PL,Kacanek D,et al.Combination Antiretroviral use and preterm birth[J].J Infect Dis,2013,207(4):612-621.
[2]Li B,Zhao Q,Zhang X,et al.Effectiveness of a prevention of mother-to-child HIV transmission program in Guangdong province from 2007 to 2010[J].BMC Public Health,2013,13:591.
[3]Hiarlaithe MO,Grede N,de Pee S,et al.Economic and social factors are some of the most common barriers preventing women from accessing maternal and newborn child health(MNCH)and prevention of mother-to-child transmission(PMTCT)services:a literature review[J].AIDS Behav,2014,18(Suppl 5):S516-30.
[4]Gourlay A,Birdthistle I,Mburu G,et al.Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa:a systematic review[J].J Int AIDS Soc,2013,16:18588.
[5]Gourlay A,Wringe A,Todd J,et al.Factors associated with uptake of services to prevent mother-to-child transmission of HIV in a community cohort in rural Tanzania[J].Sex Transm Infect,2015,91(7):520-527.
[6]马远珠,高爽,姚健,等.广东省预防艾滋病母婴传播整合服务的现状分析[J].中国妇幼卫生杂志,2015,6(6):14-17.
[7]Boateng D,Kwapong GD,Agyei-Baffour P.Knowledge,perception about antiretroviral therapy(ART)and prevention of mother-tochildtransmission(PMTCT)and adherence to ART among HIV positive women in the Ashanti Region,Ghana:a cross-sectional study[J].BMC Womens Health,2013,13(1):2.
[8]武红萍,郑佳瑞,杨海霞,等.高流行地区预防艾滋病母婴传播规律用药及影响因素分析[J].中国妇幼保健,2013,28(8):1313-1316.
[9]Wang Q,Wang L,Fang L,et al.Timely antiretroviral prophylaxis during pregnancy effectively reduces HIV mother-to-child transmission in eight counties in China:a prospective study during 2004-2011[J].Sci,6,34526.
[10]宋丽萍,耿文奎,蓝文展,等.预防HIV母婴传播干预措施利用的影响因素分析[J].中国妇幼保健,2012,27(12):1773-1777.
[11]Jones D,Peltzer K,Weiss SM,et al.Implementing comprehensive prevention of mother-to-child transmission and HIV prevention for South African couples:study protocol for a randomized controlled trial[J].Trials,2014,15(1):417.
[12]Morfaw F,Mbuagbaw L,Thabane L,et al.Male involvement in prevention programs of mother to child transmission of HIV:a systematic review to identify barriers and facilitators[J].Syst Rev,2013,2(1):5.
[13]Nlend AEN,MotazéAN,Tetang SM,et al.Preterm birth and low birth weight after in utero exposure to antiretrovirals initiated during pregnancy in Yaoundé,Cameroon[J].PLo S One,2016,11(3):e0150565.
[14]Woldesenbet S,Jackson D,Lombard C,et al.Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa:uptake,determinants,and attributable risk(the SAPMTCTE)[J].PLo S One,2015,10(7):e0132425.
[15]Colombini M1,Stockl H,Watts C,et al.Factors affecting adherence to short-course ARV prophylaxis for preventing mother-tochild transmission of HIV in sub-Saharan Africa:a review and lessons for future elimination[J].AIDS Care,2014,26(7):914-926.
[16]Aizire J,Fowler MG,Coovadia HM.Operational issues and barriers to implementation of prevention of mother-to-child transmission of HIV(PMTCT)interventions in Sub-Saharan Africa[J].Curr HIV Res,2013,11(2):144-159.
[17]Watts DH,Williams PL,Kacanek D,et al.Combination Antiretroviral use and preterm birth[J].J Infect Dis,2013,207(4):612-621.