政府主导的全方位多层次多合作平台模式阻断艾滋病母婴传播的效果
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摘要
目的评价政府主导的全方位、多层次、多合作平台模式阻断艾滋病母婴传播的效果。方法以在梧州市辖区各级医疗保健机构首诊的339 136例孕妇作为研究对象,其中2009年1月至2011年12月就诊的156 760例孕妇为对照组,以2012年1月至2014年12月就诊的182 376例孕妇为观察组。两组均给予常规艾滋病宣传教育、HIV筛查,对有继续妊娠意愿的HIV感染孕妇进行母婴抗病毒药物治疗。观察组同时采用政府主导的全方位、多层次、多合作平台的工作模式进行干预。比较两组孕妇艾滋病咨询率、HIV抗体检测率及阳性率、孕妇妊娠结局,HIV感染病例母婴抗病毒药物治疗,以及母婴传播阻断情况。结果观察组孕妇艾滋病咨询率及HIV抗体检测率、母婴抗病毒药物应用率均高于对照组(均P<0.05)。两组孕妇HIV抗体阳性率、人工终止妊娠率、婴儿18月龄时HIV检测率及阳性比较,差异均无统计学意义(均P>0.05),但观察组中70例接受HIV检测的婴儿均成功阻断了HIV的母婴传播。结论政府主导的全方位、多层次、多合作平台的防治模式能提高孕妇HIV检测率,抗病毒药物应用的及时性及依从性率,是阻断艾滋病母婴传播行之有效的工作模式。
Objective To evaluate the effect of blocking mother-to-child transmission of AIDS by government-dominated omni-directional multi-level cooperation platform model in Wuzhou City. Methods A total of 339 136 pregnant women with first visit in healthcare institutions of various levels in Wuzhou City were enrolled as subjects,including 156 760 seeing a doctor during January 2009 to December 2011 as control group and 182 376 during January 2012 to December 2014 as observation group. Both groups received conventional health education regarding AIDS as well as HIV screening,and maternal and infant antiretroviral therapy was performed in pregnant women with HIV infection and willingness to continue their pregnancy. Besides,the observation group was given intervention using a working model of government-dominated omni-directional multi-level cooperation platform. Relevant indices were compared between the two group,including proportion of pregnant women undergoing AIDS counseling or HIV antibody testing,positive rate of HIV antibody,pregnancy outcome of pregnant women,and results of maternal and infant antiretroviral therapy and mother-to-child transmission blocking of HIV infection cases. Results The observation group exhibited higher rates of AIDS counseling and HIV antibody testing of pregnant women,as well as higher rates of maternal and infant antiretroviral medication than the observation group(all P<0.05),no statistically significant difference was found between the two groups in positive rate of HIV antibody,rate of induced abortion,proportion of infants at the age of 18 months undergoing HIV testing,or positive rate of the 18-month infants(all P>0.05),however,all of the 70 infants receiving HIV testing in the observation group achieved successful mother-to-child transmission blocking of HIV. Conclusion The prevention and control model based on the government-dominated omni-directional multi-level cooperation platform is an effective working model for blocking mother-to-child transmission of HIV,which can improve rate of HIV testing,as well as timeliness and compliance for antiretroviral medication,in pregnant women.
Objective To evaluate the effect of blocking mother-to-child transmission of AIDS by government-dominated omni-directional multi-level cooperation platform model in Wuzhou City. Methods A total of 339 136 pregnant women with first visit in healthcare institutions of various levels in Wuzhou City were enrolled as subjects,including 156 760 seeing a doctor during January 2009 to December 2011 as control group and 182 376 during January 2012 to December 2014 as observation group. Both groups received conventional health education regarding AIDS as well as HIV screening,and maternal and infant antiretroviral therapy was performed in pregnant women with HIV infection and willingness to continue their pregnancy. Besides,the observation group was given intervention using a working model of government-dominated omni-directional multi-level cooperation platform. Relevant indices were compared between the two group,including proportion of pregnant women undergoing AIDS counseling or HIV antibody testing,positive rate of HIV antibody,pregnancy outcome of pregnant women,and results of maternal and infant antiretroviral therapy and mother-to-child transmission blocking of HIV infection cases. Results The observation group exhibited higher rates of AIDS counseling and HIV antibody testing of pregnant women,as well as higher rates of maternal and infant antiretroviral medication than the observation group(all P<0.05),no statistically significant difference was found between the two groups in positive rate of HIV antibody,rate of induced abortion,proportion of infants at the age of 18 months undergoing HIV testing,or positive rate of the 18-month infants(all P>0.05),however,all of the 70 infants receiving HIV testing in the observation group achieved successful mother-to-child transmission blocking of HIV. Conclusion The prevention and control model based on the government-dominated omni-directional multi-level cooperation platform is an effective working model for blocking mother-to-child transmission of HIV,which can improve rate of HIV testing,as well as timeliness and compliance for antiretroviral medication,in pregnant women.
引文
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[3]中华人民共和国卫生部.卫生部关于加强预防艾滋病母婴传播工作的指导意见[EB/OL].(2006-06-16)[2018-09-27].http://www.nhc.gov.cn/zwgk/wtwj/201304/6469a0af505d40f288097b7ebfbac024.shtml.
[4]中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南第三版(2015版)[J].中华临床感染病杂志,2015,8(5):385-401.
[5]孟琴,沈智勇,周信娟,等.广西2010-2016年不同检测来源新报告HIV/AIDS病例情况分析[J].中国艾滋病性病,2018,24(5):466-469.
[6]覃耀明,黄越华,李映.广西艾滋病监测报告暨533例艾滋病病毒抗体阳性产妇情况分析[J].广西医科大学学报,2013,30(2):314-316.
[7]张弛.贵州省HIV感染孕产妇流行特征及预防艾滋病母婴传播对策研究[D].贵阳:贵阳医学院,2014.
[8]岳一姬,金涛,刘金宝,等.新疆某艾滋病高流行地区艾滋病母婴传播阻断干预措施的成本-效果分析[J].中国卫生经济,2012,31(10):47-48.
[9]张夏燕,李萌,冯一冰,等.中国2011-2014年艾滋病母婴阻断效果的Meta分析[J].中国艾滋病性病,2015,21(4):275-279.
[10]Wang AL,Qiao YP,Wang LH,et al.Integrated prevention of mother-to-child transmission for human immunodeficiecyvirus,syphilis and hepatitis B virus in China[J].Bull World Health Organ,2015,93(1):52-56.