Nduati Eunice Wambui, Hassan Amin Shaban, Knight Miguel Garcia, Muema Daniel Muli, Jahangir Margaret Nassim, Mwaringa Shalton Lwambi, Etyang Timothy Juma, Rowland-Jones Sarah, Urban Britta Christina, Berkley James Alexander
Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya.
Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
BMC Public Health. 2015 Oct 3;15:1008. doi: 10.1186/s12889-015-2355-4.
Success in prevention of mother-to-child transmission (PMTCT) raises the prospect of eliminating pediatric HIV infection. To achieve global elimination, however, strategies are needed to strengthen PMTCT interventions. This study aimed to determine PMTCT outcomes and identify challenges facing its successful implementation in a rural setting in Kenya.
A retrospective cohort design was used. Routine demographic and clinical data for infants and mothers enrolling for PMTCT care at a rural hospital in Kenya were analysed. Cox and logistic regression were used to determine factors associated with retention and vertical transmission respectively.
Between 2006 and 2012, 1338 infants were enrolled and followed up for PMTCT care with earlier age of enrollment and improved retention observed over time. Mother to child transmission of HIV declined from 19.4 % in 2006 to 8.9 % in 2012 (non-parametric test for trend p = 0.024). From 2009 to 2012, enrolling for care after 6 months of age, adjusted Odds Ratio [aOR]: 23.3 [95 % confidence interval (CI): 8.3-65.4], presence of malnutrition ([aOR]: 2.3 [95 % CI: 1.1-5.2]) and lack of maternal use of highly active antiretroviral therapy (HAART) (aOR: 6.5 [95 % CI: 1.4-29.4]) was associated with increased risk of HIV infection. Infant's older age at enrollment, malnutrition and maternal HAART status, were also associated with drop out from care. Infants who were not actively followed up were more likely to drop out from care (adjusted Hazard Ratio: 6.6 [95 % CI: 2.9-14.6]).
We report a temporal increase in the proportion of infants enrolling for PMTCT care before 3 months of age, improved retention in PMTCT and a significant reduction in the proportion of infants enrolled who became HIV-infected, emphasizing the benefits of PMTCT.
A simple set of risk factors at enrollment can identify mother-infant pairs most at risk of infection or drop out for targeted intervention.
预防母婴传播（PMTCT）的成功为消除儿童HIV感染带来了希望。然而，要实现全球消除，需要采取策略加强PMTCT干预措施。本研究旨在确定PMTCT的结果，并找出在肯尼亚农村地区成功实施该措施所面临的挑战。
采用回顾性队列设计。分析了在肯尼亚一家农村医院接受PMTCT护理的婴儿和母亲的常规人口统计学和临床数据。分别使用Cox回归和逻辑回归来确定与留存率和垂直传播相关的因素。
2006年至2012年期间，1338名婴儿登记接受PMTCT护理并接受随访，随着时间的推移，登记年龄提前且留存率有所提高。HIV母婴传播率从2006年的19.4%降至2012年的8.9%（趋势非参数检验p = 0.024）。2009年至2012年期间，6个月龄后登记接受护理，调整后的优势比[aOR]：23.3[95%置信区间（CI）：8.3 - 65.4]，存在营养不良（[aOR]：2.3[95%CI：1.1 - 5.2]）以及母亲未使用高效抗逆转录病毒疗法（HAART）（aOR：6.5[95%CI：1.4 - 29.4]）与HIV感染风险增加相关。婴儿登记时年龄较大、营养不良和母亲的HAART状态也与护理退出有关。未积极随访的婴儿更有可能退出护理（调整后的风险比：6.6[95%CI：2.9 - 14.6]）。
我们报告了3个月龄前登记接受PMTCT护理的婴儿比例随时间增加、PMTCT留存率提高以及登记的婴儿中HIV感染比例显著降低，强调了PMTCT的益处。
一组简单的登记时风险因素可以识别出最有感染风险或最有可能退出护理的母婴对，以便进行有针对性的干预。
