坦桑尼亚产前检查门诊孕妇梅毒和艾滋病毒血清转换率：分娩时需重新筛查。
Sero-conversion rate of Syphilis and HIV among pregnant women attending antenatal clinic in Tanzania: a need for re-screening at delivery.
作者信息
Lawi John D T, Mirambo Mariam M, Magoma Moke, Mushi Martha F, Jaka Hyasinta M, Gumodoka Balthazary, Mshana Stephen E
机构信息
Ministry of health and social welfare, Department of Curative services, P.O. Box 9083, Dar esSalaam, Tanzania.
Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.
出版信息
BMC Pregnancy Childbirth. 2015 Jan 22;15:3. doi: 10.1186/s12884-015-0434-2.
BACKGROUND
Despite the available cost effective antenatal testing and treatment, syphilis and human immunodeficiency virus (HIV) are still among common infections affecting pregnant women especially in developing countries. In Tanzania, pregnant women are tested only once for syphilis and HIV during antenatal clinic (ANC) visits. Therefore, there are missed opportunities for syphilis and HIV screening among those who were not tested during ANC visits and those acquiring infections during the course of pregnancy. This study was designed to determine the syphilis and HIV seroprevalence at delivery and seroconversion rate among pregnant women delivering at Bugando Medical Centre (BMC).
METHODS
A cross sectional, hospital-based study involving pregnant women attending Bugando Medical Centre (BMC) antenatal clinic was done from January to March 2012. Serum samples were collected and tested for HIV and syphilis using HIV and syphilis rapid tests. Demographic and clinical data were collected using a standardized data collection tool and analysed using STATA version 11.
RESULTS
A total of 331 and 408 women were screened for syphilis and HIV during antenatal respectively. Of 331 women who screened negative for syphilis at ANC, nine (2.7%) were seropositive at delivery while of 391who tested negative for HIV during ANC eight (2%) were found to be positive at delivery. Six (1.8%) and 23 (9%) of women who did not screen for syphilis and HIV at ANC were seropositive for syphilis and HIV at delivery respectively. There was significant difference of seroprevalence for HIV, among women who tested negative at ANC and those who did not test at ANC (2% vs.9%, P,<0.001). The overall prevalence of syphilis and HIV at delivery was 15 (2.3%) and 48 (7.2%) respectively. Syphilis seropositivity at delivery was significantly associated with HIV co-infection (p < 0.001), male partner circumcision (p = 0.011) and alcohol use among women (p < 0.001).
CONCLUSIONS
The current protocol of screening for syphilis and HIV only once during pregnancy as practiced in Tanzania may miss women who get re-infected and seroconvert during pregnancy. Re-screening for syphilis and HIV during the course of pregnancy and at delivery is recommended in Tanzania as it can help to identify such women and institute appropriate treatment.
背景
尽管有经济有效的产前检测和治疗方法，但梅毒和人类免疫缺陷病毒（HIV）仍是影响孕妇的常见感染，尤其是在发展中国家。在坦桑尼亚，孕妇在产前检查门诊（ANC）就诊时仅接受一次梅毒和HIV检测。因此，对于那些在ANC就诊时未接受检测以及在孕期感染的孕妇来说，存在梅毒和HIV筛查的遗漏机会。本研究旨在确定在布甘多医疗中心（BMC）分娩的孕妇在分娩时的梅毒和HIV血清阳性率以及血清转换率。
方法
2012年1月至3月，在布甘多医疗中心（BMC）进行了一项基于医院的横断面研究，研究对象为参加该中心产前检查门诊的孕妇。采集血清样本，使用HIV和梅毒快速检测法检测HIV和梅毒。使用标准化数据收集工具收集人口统计学和临床数据，并使用STATA 11版进行分析。
结果
分别有331名和408名妇女在产前接受了梅毒和HIV筛查。在ANC筛查梅毒呈阴性的331名妇女中，9名（2.7%）在分娩时血清呈阳性；在ANC检测HIV呈阴性的391名妇女中，8名（2%）在分娩时被发现呈阳性。在ANC未筛查梅毒和HIV的妇女中，分别有6名（1.8%）和23名（9%）在分娩时梅毒和HIV血清呈阳性。在ANC检测呈阴性的妇女和未检测的妇女中，HIV血清阳性率存在显著差异（2%对9%，P<0.001）。分娩时梅毒和HIV的总体患病率分别为15例（2.3%）和48例（7.2%）。分娩时梅毒血清阳性与HIV合并感染（p<0.001）、男性伴侣包皮环切术（p=0.011）以及女性饮酒（p<0.001）显著相关。
结论
坦桑尼亚目前在孕期仅进行一次梅毒和HIV筛查的方案可能会遗漏在孕期再次感染和血清转换的妇女。建议在坦桑尼亚在孕期和分娩时重新筛查梅毒和HIV，因为这有助于识别此类妇女并进行适当治疗。
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