Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.
Int J Epidemiol. 2010 Aug;39(4):1066-73. doi: 10.1093/ije/dyq060. Epub 2010 May 7.
We examined HIV prevalence trends over 4.5 years among women receiving antenatal care in Kinshasa, Democratic Republic of Congo, by geographic location, clinic management and urbanicity.
Quarterly proportions and 95% confidence intervals (CIs) of pregnant women with HIV positive results were determined using aggregate service provision and uptake data from 22 maternity units that provided vertical HIV prevention services from October 2004 to March 2009. Assuming linearity, proportions were assessed for trend via the Cochran-Armitage test. Multivariable binomial regression was used to describe detailed prevalence trends.
HIV testing was offered to 220,006 pregnant women; 210,348 (95.6%) agreed to be tested and 191,216 (90.9%) received their results. A total of 3999 women were found to be HIV positive, a prevalence of 1.90% (95% CI: 1.84-1.96%). The median quarterly proportion of women testing positive for HIV was 1.94% (range: 1.44-2.44%). Prevalence was heterogeneous in terms of maternity management, urbanicity and geographic location. Modeling suggested that the overall prevalence dropped from 2.04% (95% CI: 1.92-2.16%) to 1.77% (95% CI: 1.66-1.88%) over 4.5 years, a relative decrease of 13.2% (95% CI: 3.53-22.9%). Trend testing corroborated this decline (P < 0.01).
The decreasing HIV prevalence among Kinshasa antenatal care seekers is robust and encouraging. The relatively low prevalence and the weak existing healthcare system require prevention of mother-to-child transmission interventions that strengthen maternal and child healthcare service delivery. Complacency would be unwarranted: assuming a uniform national crude birth rate of 50/1000 and 1.8% antenatal HIV prevalence, approximately 7000 pregnant HIV infected women in Kinshasa, and 60,000 nationwide, are in need of care and prevention services yearly.
我们研究了 4.5 年间在金沙萨接受产前护理的女性中 HIV 流行趋势，按地理位置、诊所管理和城市划分。
利用 2004 年 10 月至 2009 年 3 月期间 22 个提供垂直 HIV 预防服务的妇产科单位的综合服务提供和采用数据，确定了 HIV 阳性孕妇的季度比例和 95%置信区间（CI）。假设线性关系，通过 Cochran-Armitage 检验评估比例趋势。多变量二项式回归用于描述详细的流行趋势。
共向 220006 名孕妇提供了 HIV 检测；210348 名（95.6%）同意检测，191216 名（90.9%）接受了检测结果。共发现 3999 名妇女 HIV 阳性，患病率为 1.90%（95%CI：1.84-1.96%）。中位数季度 HIV 阳性妇女比例为 1.94%（范围：1.44-2.44%）。根据产妇管理、城市和地理位置的不同，患病率存在差异。模型显示，4.5 年内总体患病率从 2.04%（95%CI：1.92-2.16%）降至 1.77%（95%CI：1.66-1.88%），相对下降 13.2%（95%CI：3.53-22.9%）。趋势检验证实了这一下降（P < 0.01）。
金沙萨产前保健寻求者中 HIV 流行率的下降是稳健和令人鼓舞的。相对较低的流行率和薄弱的现有医疗保健系统需要加强母婴保健服务提供的母婴传播预防干预措施。自满是不明智的：假设全国粗出生率为 50/1000，产前 HIV 流行率为 1.8%，金沙萨每年约有 7000 名感染 HIV 的孕妇和全国 60000 名孕妇需要护理和预防服务。
