Schnippel Kathryn, Mongwenyana Constance, Long Lawrence C, Larson Bruce A
Health Economics and Epidemiology Research Office (HE2RO), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Global Health and the Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
BMC Infect Dis. 2015 Feb 6;15:46. doi: 10.1186/s12879-015-0778-2.
Between 2010-2013, South Africa implemented WHO 'Option A' for prevention of mother to child transmission (PMTCT), where all HIV-infected pregnant women (from 14 weeks gestation) received zidovudine (AZT) as ARV prophylaxis and initiated CD4 testing at their first antenatal care (ANC) visit. After returning for a second visit to collect CD4 results, women with CD4 counts ≤ 350 were referred to the ART clinic and fast-tracked for initiation on lifelong ART while continuing to visit the ANC clinic every four weeks. Women with CD4 counts >350 were dispensed daily AZT prophylaxis at monthly follow up visits (every 4 weeks). The primary objective of this study was to evaluate adherence of HIV-infected pregnant women to recommended PMTCT services at and after their first antenatal care (ANC) visit.
We conducted an observational cohort study from August 2012 to February 2013 at two primary health care clinics in Johannesburg, South Africa using routinely collected clinic data from first ANC visit for up to 60 days.
Of the 158 patients newly diagnosed with HIV at their first ANC visit, records indicated that 139 women initiated CD4 testing during their first ANC visit. 52 patients (33% of 158) did not return again to the clinic within 60 days. Of the 118 (84% of 139) women with known gestational age > 13 weeks and known Hb ≥ 8 g/dl who should have received a 4-week supply of daily AZT at first ANC visit, 81 women (69% of 118) had a record of AZT being dispensed. Among the 139 women with CD4 results, 72 (52%) were eligible for lifelong ART (CD4 count ≤350); however, only 2 initiated ART within 30 days.
Loss to initiation of both single and triple ARV therapy, loss to follow-up, and treatment interruptions were common during ANC care for pregnant women with HIV after their first ANC visit.
2010年至2013年期间，南非实施了世界卫生组织的“选项A”预防母婴传播（PMTCT）方案，即所有感染艾滋病毒的孕妇（妊娠14周起）接受齐多夫定（AZT）作为抗逆转录病毒药物预防，并在首次产前检查（ANC）时开始进行CD4检测。在复诊获取CD4检测结果后，CD4计数≤350的女性被转介至抗逆转录病毒治疗诊所，并加快启动终身抗逆转录病毒治疗，同时继续每四周前往一次产前检查诊所。CD4计数>350的女性在每月随访（每4周一次）时接受每日AZT预防治疗。本研究的主要目的是评估感染艾滋病毒的孕妇在首次产前检查及之后对推荐的预防母婴传播服务的依从性。
2012年8月至2013年2月，我们在南非约翰内斯堡的两家初级卫生保健诊所开展了一项观察性队列研究，使用首次产前检查时常规收集的诊所数据，随访长达60天。
在首次产前检查时新诊断出感染艾滋病毒的158例患者中，记录显示139名女性在首次产前检查时开始进行CD4检测。52例患者（158例中的33%）在60天内未再次返回诊所。在118名已知孕周>13周且已知血红蛋白≥8 g/dl、应在首次产前检查时获得为期4周的每日AZT供应的女性中，81名女性（118名中的69%）有AZT发放记录。在139名有CD4检测结果的女性中，72名（52%）符合终身抗逆转录病毒治疗条件（CD4计数≤350）；然而，只有2名在30天内开始接受抗逆转录病毒治疗。
在感染艾滋病毒的孕妇首次产前检查后的产前护理期间，单药和三联抗逆转录病毒治疗的起始失访、随访失访以及治疗中断情况较为常见。
