Finocchario-Kessler Sarah, Clark Kristine F, Khamadi Samoel, Gautney Brad J, Okoth Vincent, Goggin Kathy
Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Global Studies, University of Kansas, Lawrence, KS, USA.
AIDS Behav. 2016 Nov;20(11):2602-2611. doi: 10.1007/s10461-015-1071-5.
We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p's < 0.001). Pediatric HIV infection was halved (8.6-4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.
我们分析了来自一个回顾性队列的预防母婴传播（PMTCT）数据，该队列包含1365名感染艾滋病毒的母亲，她们于2010年至2012年期间在肯尼亚的四家政府医院为其接触过艾滋病毒的婴儿登记了早期婴儿诊断服务。分别只有不到15%和20%的母婴对接受了符合世界卫生组织A方案和B/B+方案指南的治疗方案。每年，开始治疗时的孕周在下降，而采用B/B+方案的比例在上升（所有p值均<0.001）。儿童艾滋病毒感染率减半（从8.6%降至4.3%），但各医院之间差异显著。在多变量分析中，未接受预防母婴传播治疗的接触过艾滋病毒的婴儿（调整后比值比[AOR]为4.6[2.49, 8.62]，p<0.001）、食用混合食物的婴儿（AOR为5.0[2.77, 9.02]，p<0.001）以及在四家医院之一接受护理的婴儿（AOR为3.0[1.51, 5.92]，p = 0.002）感染艾滋病毒的可能性更大。虽然世界卫生组织预防母婴传播指南的实施和采用情况正在改善，但进一步关注留住率和药物依从性将进一步减少儿童艾滋病毒传播。
