Dignitas International, Zomba, Malawi.
BMC Public Health. 2011 Jun 3;11:426. doi: 10.1186/1471-2458-11-426.
HIV prevalence among pregnant women in Malawi is 12.6%, and mother-to-child transmission is a major route of transmission. As PMTCT services have expanded in Malawi in recent years, we sought to determine uptake of services, HIV-relevant infant feeding practices and mother-child health outcomes.
A matched-cohort study of HIV-infected and HIV-uninfected mothers and their infants at 18-20 months post-partum in Zomba District, Malawi. 360 HIV-infected and 360 HIV-uninfected mothers were identified through registers. 387 mother-child pairs were included in the study.
10% of HIV-infected mothers were on HAART before delivery, 27% by 18-20 months post-partum. sd-NVP was taken by 75% of HIV-infected mothers not on HAART, and given to 66% of infants. 18% of HIV-infected mothers followed all current recommended PMTCT options. HIV-infected mothers breastfed fewer months than HIV-uninfected mothers (12 vs.18, respectively; p < 0.01). 19% of exposed versus 5% of unexposed children had died by 18-20 months; p < 0.01. 28% of exposed children had been tested for HIV prior to the study, 76% were tested as part of the study and 11% were found HIV-positive. HIV-free survival by 18-20 months was 66% (95%CI 58-74). There were 11(6%) maternal deaths among HIV-infected mothers only.
This study shows low PMTCT program efficiency and effectiveness under routine program conditions in Malawi. HIV-free infant survival may have been influenced by key factors, including underuse of HAART, underuse of sd-NVP, and suboptimal infant feeding practices. Maternal mortality among HIV-infected women demands attention; improved maternal survival is a means to improve infant survival.
马拉维孕妇的 HIV 感染率为 12.6%，母婴传播是主要的传播途径。近年来，随着马拉维 PMTCT 服务的扩大，我们试图确定服务的利用率、与 HIV 相关的婴儿喂养方式以及母婴健康结局。
在马拉维宗巴区，对感染 HIV 和未感染 HIV 的产妇及其产后 18-20 个月的婴儿进行了一项匹配队列研究。通过登记册确定了 360 名 HIV 感染和 360 名 HIV 未感染的母亲。研究纳入了 387 对母婴。
10%的 HIV 感染母亲在分娩前接受了 HAART，27%在产后 18-20 个月接受了 HAART。未接受 HAART 的 75%HIV 感染母亲服用了 sd-NVP，其中 66%的婴儿服用了 sd-NVP。18%的 HIV 感染母亲遵循了所有当前推荐的 PMTCT 选择。HIV 感染母亲的母乳喂养时间少于 HIV 未感染母亲（分别为 12 个月和 18 个月；p<0.01）。18-20 个月时，暴露组有 19%的儿童死亡，而未暴露组有 5%的儿童死亡（p<0.01）。暴露组中有 28%的儿童在研究前接受了 HIV 检测，76%的儿童作为研究的一部分接受了检测，11%的儿童 HIV 检测呈阳性。18-20 个月时 HIV 无生存者为 66%（95%CI 58-74）。HIV 感染母亲中有 11 例（6%）死亡。
这项研究表明，在马拉维常规方案条件下，PMTCT 方案的效率和效果较低。HIV 无生存婴儿的生存可能受到关键因素的影响，包括 HAART 的使用不足、sd-NVP 的使用不足以及婴儿喂养方式的不理想。HIV 感染妇女的孕产妇死亡率需要引起关注；提高孕产妇生存率是提高婴儿生存率的一种手段。
