Clínica de Familia MIR, La Romana, Dominican Republic.
Rev Panam Salud Publica. 2009 Oct;26(4):315-23. doi: 10.1590/s1020-49892009001000005.
To strengthen prevention of mother-to-child HIV transmission (pMTCT) program implementation in La Romana (LR) province, by estimating HIV prevalence and identifying characteristics associated with HIV infection in parturients.
Umbilical cord blood samples were collected at seven obstetrical sites where over 95% of LR's deliveries occur during four phases (pilot, expanded pilot, full study, and pMTCT program monitoring) from 2 August 2002 to 30 September 2006. Results were linked to data abstracted from delivery records.
HIV seroprevalence was 2.6% (263/10 040 overall; 114/4 452, full-study phase (95% confidence interval = 2.1%-3.1%)). Most HIV-infected parturients were Dominican (68.9%) and urban (64.0%). However, prevalence was higher among Haitians (3.7%) than Dominicans (2.3% (p < 0.001)), especially those aged 21-25 years (5.2% vs. 2.3% (p < 0.001)), and among rural, batey, and peri-urban (vs. urban) parturients (3.4% vs. 2.3%, (p = 0.003)). HIV prevalence was associated with commercial sex work (reported by only 0.4%), and prior pregnancy. In logistic regression analysis, commercial sex work, Haitian nationality, and prior pregnancy were independently associated with HIV infection. Caesarean deliveries were more frequent, and rose in the last years of the study, among HIV seropositives; however, most deliveries among seropositives (57.5%) were vaginal.
HIV prevalence among LR parturients was higher than the estimated prevalence in the Dominican Republic (0.8%-1.0%) and, in contrast to past studies, predominantly affected urban Dominicans. HIV prevalence among LR Haitian parturients was higher than among Dominican counterparts and prenatal clinic attendees in Haiti (who had a rate of 3.1%). Consistently implemented, targeted pMTCT interventions are needed.
加强拉罗马纳省（LR）母婴 HIV 传播（pMTCT）项目的预防工作，通过评估产妇 HIV 感染率并确定与 HIV 感染相关的特征。
2002 年 8 月 2 日至 2006 年 9 月 30 日，在七个产科地点采集脐带血样本，这些地点覆盖了 LR 95%以上的分娩量，研究共分为四个阶段（试点、扩大试点、全面研究和 pMTCT 项目监测）。研究结果与从分娩记录中提取的数据相关联。
HIV 血清阳性率为 2.6%（10040 例总体中 263 例；4452 例全面研究阶段中有 114 例[95%置信区间为 2.1%-3.1%]）。大多数感染 HIV 的产妇是多米尼加人（68.9%）和城市居民（64.0%）。然而，海地人感染 HIV 的比例（3.7%）高于多米尼加人（2.3%（p<0.001）），尤其是 21-25 岁的海地人（5.2%比 2.3%（p<0.001）），以及农村、bateau 和城市周边地区（与城市地区相比）的海地人（3.4%比 2.3%（p=0.003））。HIV 感染率与商业性性行为（仅 0.4%报告）和既往妊娠相关。在 logistic 回归分析中，商业性性行为、海地国籍和既往妊娠与 HIV 感染独立相关。在 HIV 血清阳性者中，剖宫产分娩更为常见，且在研究的最后几年有所增加；然而，血清阳性者中大多数分娩（57.5%）为阴道分娩。
LR 产妇的 HIV 感染率高于多米尼加共和国的估计感染率（0.8%-1.0%），与以往的研究不同，该地区受感染的主要是城市多米尼加人。LR 海地产妇的 HIV 感染率高于多米尼加对照者和海地产前诊所就诊者（他们的感染率为 3.1%）。需要持续实施有针对性的 pMTCT 干预措施。
