Ronen Keshet, McGrath Christine J, Langat Agnes C, Kinuthia John, Omolo Danvers, Singa Benson, Katana Abraham K, NgʼAngʼA Lucy W, John-Stewart Grace
*Departments of Global Health and Epidemiology, University of Washington, Seattle, WA; †Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX; ‡Centers for Disease Control and Prevention (CDC), Nairobi, Kenya; §Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya; ‖Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; and ¶Departments of Global Health, Epidemiology, Medicine and Pediatrics, University of Washington, Seattle, WA.
J Acquir Immune Defic Syndr. 2017 Jan 1;74(1):30-37. doi: 10.1097/QAI.0000000000001176.
Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya.
We conducted a nationally representative cross-sectional survey of mother-infant pairs attending 120 maternal child health clinics selected by probability proportionate to size sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. Antenatal care (ANC) attendance, HIV testing, and antiretroviral (ARV) use were compared between adolescent (age ≤19 years) and adult mothers using χ tests and logistic regression.
Among 2521 mothers, 278 (12.8%) were adolescents. Adolescents were less likely than adults to be employed (16.5% vs. 37.9%), married (66.1% vs. 88.3%), have intended pregnancy (40.5% vs. 58.6%), or have disclosed their HIV status (77.5% vs. 90.7%) (P < 0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2% vs. 45.6%, P = 0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity, and HIV status [adjusted odds ratio (95% confidence interval) = 0.54 (0.37 to 0.97), P = 0.001]. Among 2359 women without previous HIV testing, 96.1% received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on antiretroviral therapy before pregnancy, adolescents were less likely than adults to be on ARVs (65.0% vs. 85.8%, P = 0.01) or to have infants on ARVs (85.7% vs. 97.7%, P = 0.005).
Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade.
青少年中的怀孕率和艾滋病毒感染率很高。然而，他们参与预防母婴传播艾滋病毒（PMTCT）服务的情况却鲜有描述。我们比较了肯尼亚成年母亲和青少年母亲在PMTCT流程中的参与情况。
我们对在120家母婴健康诊所就诊的母婴对进行了一项具有全国代表性的横断面调查，这些诊所通过按规模大小概率抽样选取，在30家诊所对艾滋病毒呈阳性的母亲进行了二次调查并进行了过抽样。使用χ检验和逻辑回归比较了青少年（年龄≤19岁）和成年母亲的产前保健（ANC）就诊情况、艾滋病毒检测情况及抗逆转录病毒药物（ARV）的使用情况。
在2521名母亲中，278名（12.8%）为青少年。青少年比成年人就业的可能性更小（16.5%对37.9%）、结婚的可能性更小（66.1%对88.3%）、有计划怀孕的可能性更小（40.5%对58.6%），或者披露其艾滋病毒感染状况的可能性更小（77.5%对90.7%）（所有P<0.01）。青少年比成年人进行≥4次ANC就诊的可能性更小（35.2%对45.6%，P = 0.002）。在对就业、家庭拥挤程度、怀孕意愿、妊娠次数和艾滋病毒感染状况进行调整后，这种影响仍然显著[调整后的优势比（95%置信区间）= 0.54（0.37至0.97），P = 0.001]。在2359名之前未进行过艾滋病毒检测的女性中，96.1%在孕期接受了检测；青少年和成年人的检测水平没有差异。在288名怀孕前未接受抗逆转录病毒治疗的艾滋病毒呈阳性女性中，青少年比成年人接受抗逆转录病毒药物治疗的可能性更小（65.0%对85.8%，P = 0.01），或者让婴儿接受抗逆转录病毒药物治疗的可能性更小（85.7%对97.7%，P = 0.005）。
青少年母亲在ANC就诊和接受用于PMTCT的抗逆转录病毒药物方面情况较差。需要有针对性的干预措施来提高这一弱势群体在PMTCT流程中的留存率。
