HIV 快速检测作为巴西预防母婴传播的关键策略。
HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil.
机构信息
Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
出版信息
Rev Saude Publica. 2010 Oct;44(5):803-11. doi: 10.1590/s0034-89102010005000034. Epub 2010 Sep 8.
OBJECTIVE
To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission.
METHODS
Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied.
RESULTS
HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79).
CONCLUSIONS
The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.
目的
评估在妇产科医院产妇入院时进行 HIV 快速检测的可行性，以及随后采取干预措施降低围产期 HIV 传播的效果。
方法
本研究采用便利抽样方法，选取 2000 年 3 月至 2002 年 4 月间在巴西里约热内卢和阿雷格里港公立妇产科医院分娩、入院时不知道 HIV 血清学状况的妇女作为研究对象。对这些妇女进行咨询并使用 Determine HIV1/2 快速检测试剂进行检测。采用巴西 HIV 感染诊断算法对 HIV 感染进行确认。采用 HIV-DNA-PCR 检测确定母婴垂直传播情况。对按城市划分的社会人口学数据、既往妊娠和流产次数、产前检查次数、HIV 检测时间、HIV 快速检测结果、新生儿和母婴传播干预措施等进行描述性分析。
结果
在阿雷格里港，1439 名妇女（6.5%）HIV 检测结果阳性，而在里约热内卢，3778 名妇女（1.3%）HIV 检测结果阳性。在阿雷格里港，大多数妇女在分娩时（88.7%）接受检测，而在里约热内卢，大多数妇女在产后（67.5%）接受检测。在这两个城市，143 名 HIV 感染妇女所生的 144 名婴儿中，除 1 名外，其余均接受了至少一次口服齐多夫定预防治疗。在阿雷格里港和里约热内卢，分别有 96.8%和 51.1%的婴儿完全避免了暴露于母乳。在阿雷格里港和里约热内卢，分别有 68.8%和 27.7%的新生儿在分娩期间接受了静脉注射齐多夫定。在出生后 48 小时内采集了血液样本的婴儿中，在里约热内卢，有 4 例（4/47）确认存在母婴垂直传播，在阿雷格里港，有 6 例（6/79）确认存在母婴垂直传播。
结论
在里约热内卢和阿雷格里港的妇产科医院实施该策略是可行的。必须努力在分娩期间最大限度地增加 HIV 检测。需要得到强有力的社会支持，以确保这部分人群在出院后能够获得医疗服务。
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