Rollins Nigel, Little Kirsty, Mzolo Similo, Horwood Christiane, Newell Marie-Louise
Department of Paediatrics and Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella 4013, South Africa.
AIDS. 2007 Jun 19;21(10):1341-7. doi: 10.1097/QAD.0b013e32814db7d4.
Surveillance programmes for prevention of mother-to-child transmission of HIV (PMTCT) fail to quantify numbers of infant HIV infections averted, often because of poor postnatal follow-up. Additionally, infected infants are often not identified early and only gain access to comprehensive HIV care and treatment late in their disease.
Anonymous, unlinked, HIV prevalence testing was conducted on dried blood spot (DBS) samples from all infants attending 6 week immunization clinics at seven primary health care clinics offering PMTCT. Samples were tested for HIV antibodies (indicating maternal HIV infection) and those determined to be from HIV-exposed infants were tested for HIV RNA by polymerase chain reaction. Infant and child mortality rates were determined using birth histories.
Samples were collected from 2489 infants aged 4-8 weeks. HIV antibodies were identified in 931 infants [37.4%; 95% confidence interval (CI), 35.4-39.4], of whom 188 were HIV RNA positive. The estimated vertical transmission rate (VTR) was 20.2% (95% CI, 17.8-23.1%); 7.5% of all infants at this age were infected. Amongst mothers who reported that they had taken single-dose nevirapine for PMTCT, VTR was 15.0%. Amongst women who reported being HIV uninfected but whose infants had HIV antibodies, VTR was 30.5%. Infant mortality rates in KwaZulu Natal increased from 28/1000 live births in 1990-1994 to 92/1000 in 2000-2004.
Anonymous HIV prevalence screening of all infants at immunization clinics is feasible to monitor the impact of PMTCT programmes on peripartum infection; linked screening could identify infected children early for referral into care and treatment programmes.
预防母婴传播艾滋病毒（PMTCT）的监测项目往往无法量化避免的婴儿艾滋病毒感染数量，这通常是由于产后随访不佳所致。此外，受感染婴儿往往未能得到早期诊断，只能在疾病晚期才能获得全面的艾滋病毒护理和治疗。
对七家提供PMTCT的初级保健诊所六周免疫门诊的所有婴儿的干血斑（DBS）样本进行匿名、非关联的艾滋病毒流行率检测。对样本进行艾滋病毒抗体检测（表明母亲感染艾滋病毒），对于确定为艾滋病毒暴露婴儿的样本，通过聚合酶链反应检测艾滋病毒RNA。使用出生记录确定婴儿和儿童死亡率。
收集了2489名4至8周龄婴儿的样本。931名婴儿检测出艾滋病毒抗体[37.4%；95%置信区间（CI），35.4 - 39.4]，其中188名艾滋病毒RNA呈阳性。估计垂直传播率（VTR）为20.2%（95%CI，17.8 - 23.1%）；这个年龄段所有婴儿中有7.5%受到感染。在报告为预防母婴传播服用单剂量奈韦拉平的母亲中，垂直传播率为15.0%。在报告未感染艾滋病毒但其婴儿检测出艾滋病毒抗体的妇女中，垂直传播率为30.5%。夸祖鲁 - 纳塔尔省的婴儿死亡率从1990 - 1994年的每1000例活产28例增至2000 - 2004年的每1000例92例。
在免疫门诊对所有婴儿进行匿名艾滋病毒流行率筛查对于监测预防母婴传播项目对围产期感染的影响是可行的；关联筛查可以早期识别受感染儿童以便转诊至护理和治疗项目。
