Centre for International Health, University of Bergen, OverlegeDanielssens Hus, Årstav. 21, Bergen 5020, Norway.
J Int AIDS Soc. 2011 Oct 21;14:50. doi: 10.1186/1758-2652-14-50.
BACKGROUND: Prevention of mother to child HIV transmission (PMTCT) programmes have great potential to achieve virtual elimination of perinatal HIV transmission provided that PMTCT recommendations are properly followed. This study assessed mothers and infants adherence to medication regimen for PMTCT and the proportions of exposed infants who were followed up in the PMTCT programme. METHODS: A prospective cohort study was conducted among 282 HIV-positive mothers attending 15 health facilities in Addis Ababa, Ethiopia. Descriptive statistics, bivariate and mulitivariate logistic regression analyses were done. RESULTS: Of 282 mothers enrolled in the cohort, 232 (82%, 95% CI 77-86%) initiated medication during pregnancy, 154 (64%) initiated combined zidovudine (ZDV) prophylaxis regimen while 78 (33%) were initiated lifelong antiretroviral treatment (ART). In total, 171 (60%, 95% CI 55-66%) mothers ingested medication during labour. Of the 221 live born infants (including two sets of twins), 191 (87%, 95% CI 81-90%) ingested ZDV and single-dose nevirapine (sdNVP) at birth. Of the 219 live births (twin births were counted once), 148 (68%, 95% CI 61-73%) mother-infant pairs ingested their medication at birth. Medication ingested by mother-infant pairs at birth was significantly and independently associated with place of delivery. Mother-infant pairs attended in health facilities at birth were more likely (OR 6.7 95% CI 2.90-21.65) to ingest their medication than those who were attended at home. Overall, 189 (86%, 95% CI 80-90%) infants were brought for first pentavalent vaccine and 115 (52%, 95% CI 45-58%) for early infant diagnosis at six-weeks postpartum. Among the infants brought for early diagnosis, 71 (32%, 95% CI 26-39%) had documented HIV test results and six (8.4%) were HIV positive. CONCLUSIONS: We found a progressive decline in medication adherence across the perinatal period. There is a big gap between mediation initiated during pregnancy and actually ingested by the mother-infant pairs at birth. Follow up for HIV-exposed infants seem not to be organized and is inconsistent. In order to maximize effectiveness of the PMTCT programme, the rate of institutional delivery should be increased, the quality of obstetric services should be improved and missed opportunities to exposed infant follow up should be minimized.
背景：预防母婴传播艾滋病毒（PMTCT）方案具有很大的潜力，可以实现围产期艾滋病毒传播的几乎消除，前提是正确遵循 PMTCT 建议。本研究评估了母亲和婴儿对 PMTCT 药物治疗方案的依从性，以及在 PMTCT 方案中接受随访的暴露婴儿比例。
方法：在埃塞俄比亚亚的斯亚贝巴的 15 个卫生设施中，对 282 名感染艾滋病毒的母亲进行了前瞻性队列研究。进行了描述性统计、双变量和多变量逻辑回归分析。
结果：在 282 名入组的母亲中，有 232 名（82%，95%CI 77-86%）在孕期开始服药，154 名（64%）开始联合齐多夫定（ZDV）预防方案，78 名（33%）开始终身抗逆转录病毒治疗（ART）。总共，有 171 名（60%，95%CI 55-66%）母亲在分娩时服药。在 221 名活产婴儿（包括两对双胞胎）中，有 191 名（87%，95%CI 81-90%）在出生时服用了齐多夫定和单剂量奈韦拉平（sdNVP）。在 219 例活产儿（双胞胎出生算作一次）中，有 148 名（68%，95%CI 61-73%）母婴对在出生时服用了药物。母婴在出生时服用药物与分娩地点显著相关。在分娩时在医疗机构接受治疗的母婴对更有可能（OR 6.7，95%CI 2.90-21.65）服用药物。总的来说，有 189 名（86%，95%CI 80-90%）婴儿在产后 6 周时接受了第一次五联疫苗接种，有 115 名（52%，95%CI 45-58%）婴儿接受了早期婴儿诊断。在接受早期诊断的婴儿中，有 71 名（32%，95%CI 26-39%）有记录的艾滋病毒检测结果，有 6 名（8.4%）呈阳性。
结论：我们发现，在围产期期间，药物依从性呈逐渐下降趋势。在母亲和婴儿在孕期开始服药和实际在出生时服用之间存在很大差距。对艾滋病毒暴露婴儿的随访似乎没有组织，也不一致。为了最大限度地提高 PMTCT 方案的效果，应增加机构分娩率，提高产科服务质量，并尽量减少错过暴露婴儿随访的机会。
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