Kirere Mathe M, Sondag-Thull D, Lepage P
Nursing College of the Evangelical Medical Center of Nyankunde, Nyankunde, Democratic Republic of Congo.
J Med Virol. 2008 May;80(5):772-6. doi: 10.1002/jmv.21156.
The HIV NET 012 protocol for prevention of perinatal transmission of HIV, a single-dose of nevirapine given to the mother during labor and one given to the newborn, has been adopted by several developing countries. The implementation of this protocol may be difficult in African rural regions and must be evaluated. The study was carried out at the Oicha General Hospital, Democratic Republic of Congo. HIV-infected women with a gestational age > or =36 weeks were offered participation in the study during a prenatal visit. Among the 5,016 women tested during prenatal attendance from December 2002 to December 2004, 94 (1.9%, 95% confidence interval [CI]: 1.5-2.3%) were HIV-infected. Among these women, 59 (62.8%; 95% CI: 53.0-72.6%) received nevirapine and 35 (37.2%; 95% CI: 27.4-47.0%) did not receive nevirapine prophylaxis. Twenty-six (27.7%) of these women arrived fully dilated and 9 (9.5%) were not given the drug by the midwives. Among the 59 HIV-infected pregnant women who received nevirapine before delivery, 33 (55.9%, 95% CI: 43.2-68.6%) received the drug at the start of uterine contractions and 24 (40.7%; 95% CI: 28.2-53.2%) did not receive nevirapine within the recommended time before delivery. Two women (3.4%) received nevirapine, but this was not written in the logbook. Overall, among the 101 newborns, all children received a single-dose nevirapine: 48 (47.5%; 95% CI: 37.8-57.2%) of the 101 newborns received nevirapine in the 24-72 hr following birth and 52 (51.5%; 95% CI: 41.8-61.2%) just after birth when their mother did not receive nevirapine. Even for a protocol as simple as HIV prophylaxis with a single-dose nevirapine, the application in African rural areas encounters field difficulties. Further simplified procedures and health care re-organization are still needed to guarantee a full Prevention of Mother to Child Transmission coverage for every HIV pregnant woman in Africa.
预防艾滋病毒围产期传播的HIV NET 012方案，即在分娩期间给母亲单剂量服用奈韦拉平，并给新生儿服用一剂，已被多个发展中国家采用。在非洲农村地区实施该方案可能会有困难，必须进行评估。该研究在刚果民主共和国的奥伊查综合医院开展。孕周≥36周的艾滋病毒感染女性在产前检查时被邀请参与研究。在2002年12月至2004年12月产前检查期间接受检测的5016名女性中，94名（1.9%，95%置信区间[CI]：1.5 - 2.3%）为艾滋病毒感染者。在这些女性中，59名（62.8%；95%CI：53.0 - 72.6%）接受了奈韦拉平，35名（37.2%；95%CI：27.4 - 47.0%）未接受奈韦拉平预防用药。这些女性中有26名（27.7%）宫口全开时到达，9名（9.5%）助产士未给她们用药。在59名分娩前接受奈韦拉平的艾滋病毒感染孕妇中，33名（55.9%，95%CI：43.2 - 68.6%）在子宫收缩开始时用药，24名（40.7%；95%CI：28.2 - 53.2%）在分娩前推荐时间内未接受奈韦拉平。两名女性（3.4%）接受了奈韦拉平，但日志中未记录。总体而言，在101名新生儿中，所有儿童都接受了单剂量奈韦拉平：101名新生儿中有48名（47.5%；95%CI：37.8 - 57.2%）在出生后24 - 72小时内接受了奈韦拉平，52名（51.5%；95%CI：41.8 - 61.2%）在其母亲未接受奈韦拉平的情况下出生后立即接受了奈韦拉平。即使是像单剂量奈韦拉平预防艾滋病毒这样简单的方案，在非洲农村地区应用时也会遇到实际困难。仍需要进一步简化程序和重组医疗保健，以确保为非洲每一位感染艾滋病毒的孕妇全面预防母婴传播。
