Zhou Huan, Liu Lu, Zhang Min, Chen Xingzhi, Huang Zhaohui
The First Affiliated Hospital of Bengbu Medical College, Bengbu, China; Health Management Department, Bengbu Medical College, Bengbu, China.
Health Management Department, Bengbu Medical College, Bengbu, China.
Am J Infect Control. 2016 Mar 1;44(3):e25-35. doi: 10.1016/j.ajic.2015.10.034. Epub 2015 Dec 28.
The objectives of this study were to estimate the antiretroviral therapy (ART) rate and the proportion of women with adequate ART adherence (100%), and to identify the reasons for not initiating ART in HIV-infected pregnant women in China.
We searched MEDLINE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang (Chinese) to identify research studies published from 1990-2015. Only descriptive epidemiologic studies were eligible for this study.
A total of 58 eligible studies were included in this meta-analysis. The eligible articles were published from 2006-2015 and covered all Chinese provinces. The estimated ART rate in HIV-positive pregnant women was continually increased, and the mean estimated ART rate increased from 47.1% (95% confidence interval [CI], 22.4-71.8) in 2006 to 95.0% (95% CI, 93.2-96.0) in 2013. In the meta-regression model, study year, study region, and income level were statistically significantly associated with ART rate estimates. During the last 10 years, the pooled ART adherence proportions for all studies yielded an estimate of 76.7% (95% CI, 61.0-92.5) of patients with adequate ART adherence (100%). Emergency cesarean delivery (57.9%; 95% CI, 9.9-100) and not knowing their HIV-infection status before starting (45.7%; 95% CI, 24.4-67.0) account for the dominant reasons for not initiating ART.
The geographic variation in ART rate of HIV-infected pregnant women was significant in China, and >25% of pregnant women did not achieved optimal ART adherence. It is crucial to investigate specific barriers for lower ART rates in the high-income regions and to develop interventions to maintain the adequate ART adherence.
本研究的目的是估计抗逆转录病毒疗法（ART）的使用率以及ART依从性良好（100%）的女性比例，并确定中国HIV感染孕妇未开始接受ART治疗的原因。
我们检索了MEDLINE、中国知网、中国生物医学文献数据库和万方数据库（中文），以识别1990年至2015年发表的研究。只有描述性流行病学研究符合本研究的条件。
本荟萃分析共纳入58项符合条件的研究。符合条件的文章发表于2006年至2015年，覆盖中国所有省份。HIV阳性孕妇的估计ART使用率持续上升，平均估计ART使用率从2006年的47.1%（95%置信区间[CI]，22.4 - 71.8）增至2013年的95.0%（95%CI，93.2 - 96.0）。在荟萃回归模型中，研究年份、研究地区和收入水平与ART使用率估计值在统计学上显著相关。在过去10年中，所有研究的汇总ART依从性比例估计为76.7%（95%CI，61.0 - 92.5）的患者ART依从性良好（100%）。急诊剖宫产（57.9%；95%CI，9.9 - 100）和开始治疗前不知道自己的HIV感染状况（45.7%；95%CI，24.4 - 67.0）是未开始接受ART治疗的主要原因。
中国HIV感染孕妇的ART使用率存在显著的地理差异，超过25%的孕妇未达到最佳ART依从性。调查高收入地区较低ART使用率的具体障碍并制定干预措施以维持足够的ART依从性至关重要。
