Zeng Huan, Chow Eric P F, Zhao Yong, Wang Yang, Tang Maozhi, Li Leyu, Tang Xue, Liu Xi, Zhong Yi, Wang Ailing, Lo Ying-Ru, Zhang Lei
School of Public Health and Management, Chongqing Medical University, Chongqing, China China Effective Health Care Network, Chongqing, China Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Australia Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
Sex Transm Infect. 2016 Mar;92(2):116-23. doi: 10.1136/sextrans-2014-051877. Epub 2015 May 2.
The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade.
Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003-2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas antiretroviral (ARV) prophylaxis uptake increased from 35.2% (12.2% to 47.3%) and 26.9% (24.3% to 28.9%) to 86.2% (53.2% to 97.2%) and 90.3% (85.5% to 93.7%). HIV vertical transmission rate substantially decreased from 31.8% (25.7% to 38.6%) prior to the programme to 2.3% (1.4% to 3.8%) in 2011. During 2003-2011, among 25,312 (23,995-26,644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564-1395) were diagnosed with HIV, corresponding to an average transmission rate of 3.9% (3.2% to 4.6%). However, while including transmissions among HIV-positive pregnant women who were lost along the cascade, the average transmission rate during 2003-2011 was 17.4% (15.8% to 19.0%).
PMTCT programmes have reduced HIV mother-to-child transmission in China. Further improvements in the continuum of care remain essential in realising the full potential of the programme.
中国政府每年投入1.4亿美元用于预防艾滋病母婴传播（PMTCT）。本研究通过考察艾滋病母婴传播防治流程中项目覆盖范围、艾滋病毒检测及抗病毒药物提供方面的改善情况，对该项目进行评估。
通过全面系统地回顾2003年至2011年期间发表的经同行评审的英文和中文文献，收集艾滋病母婴传播防治流程指标数据。根据系统评价和Meta分析的首选报告项目指南进行Meta分析。
本研究纳入113篇出版物。在过去十年中，接受产前护理（ANC）的中国孕妇中艾滋病毒感染率仍低于0.1%。接受产前护理的孕妇及18个月时艾滋病毒暴露婴儿的艾滋病毒检测覆盖率从2003年的62.4%（95%可信区间4.7%至98.2%）和22.1%（16.3%至32.3%）分别显著增至2011年的90.3%（88.4%至91.8%）和82.8%（66.9%至99.5%），而抗逆转录病毒（ARV）预防用药率则从35.2%（12.2%至47.3%）和26.9%（24.3%至28.9%）增至86.2%（53.2%至97.2%）和90.3%（85.5%至93.7%）。艾滋病毒垂直传播率从项目实施前的31.8%（25.7%至38.6%）大幅降至2011年的2.3%（1.4%至3.8%）。在2003年至2011年期间，25312名（23995至26644名）接受抗逆转录病毒预防用药的艾滋病毒阳性母亲所生婴儿中，975名（564至1395名）被诊断感染艾滋病毒，平均传播率为3.9%（3.2%至4.6%）。然而，若将防治流程中失访的艾滋病毒阳性孕妇中的传播情况纳入计算，2003年至2011年期间的平均传播率为17.4%（15.8%至19.0%）。
艾滋病母婴传播防治项目已降低了中国的艾滋病毒母婴传播率。要充分发挥该项目的潜力，持续改善护理的连续性仍然至关重要。
