Dabis F, Newell M L, Fransen L, Saba J, Lepage P, Leroy V, Cartoux M, Meda N, Whynes D K, Peckham C, Nduati R, Msellati P, Vincenzi I D, van de Perre P
Unité INSERM No. 330, Université Victor Segalen Bordeaux 2, France.
Health Policy Plan. 2000 Mar;15(1):34-42. doi: 10.1093/heapol/15.1.34.
Different approaches to prevent mother-to-child transmission of HIV are being evaluated in developing countries. The first trials using a short regimen of zidovudine have been successful in Thailand, Côte d'Ivoire and Burkina Faso. International and local strategies are now being considered. The Ghent International Working Group on Mother-to-Child Transmission of HIV developed public health policy options to integrate these interventions into basic and maternal and child health (MCH) services.
The following tasks were undertaken: a critical review of randomized trials; an international pooled analysis of late postnatal transmission of HIV through breastfeeding; a review of the cost-effectiveness and cost-benefit of antiretroviral prophylaxis; a feasibility assessment of preventive strategies, including a postal survey on HIV voluntary counselling and testing (VCT) of pregnant women; the identification of requirements and research priorities for prenatal, obstetric and paediatric care. These projects provided the background for a three-day workshop in Ghent, Belgium, in November 1997. Conclusions were further refined, based on 1998 research findings.
A summary of relevant evidence and ten public health recommendations are reported. VCT for pregnant women, a short regimen of zidovudine together with alternatives to breastfeeding currently represent the best option to reduce vertical transmission in most developing countries. The primary goal of the integrated package supporting these interventions is to alleviate overall maternal and infant morbidity and mortality.
Prevention of mother-to-child transmission of HIV should now be considered for integration into basic health and MCH services of selected countries, with the involvement of governments and donor agencies.
在发展中国家，正在评估预防母婴传播艾滋病毒的不同方法。在泰国、科特迪瓦和布基纳法索，首次使用齐多夫定短疗程方案的试验已取得成功。目前正在考虑国际和地方战略。根特国际艾滋病毒母婴传播问题工作小组制定了公共卫生政策选项，以便将这些干预措施纳入基本及母婴保健服务。
开展了以下工作：对随机试验进行严格审查；对艾滋病毒通过母乳喂养进行的产后晚期传播进行国际汇总分析；对抗逆转录病毒预防措施的成本效益和成本效益进行审查；对预防战略进行可行性评估，包括对孕妇艾滋病毒自愿咨询和检测进行邮政调查；确定产前、产科和儿科护理的要求和研究重点。这些项目为1997年11月在比利时根特举行的为期三天的研讨会提供了背景。根据1998年的研究结果，结论得到了进一步完善。
报告了相关证据摘要和十项公共卫生建议。为孕妇提供自愿咨询和检测、齐多夫定短疗程方案以及母乳喂养替代方法，目前是大多数发展中国家减少垂直传播的最佳选择。支持这些干预措施的综合方案的主要目标是减轻孕产妇和婴儿的总体发病率和死亡率。
现在应考虑将预防艾滋病毒母婴传播纳入选定国家的基本卫生和母婴保健服务，并让政府和捐助机构参与其中。
