Ashiono Everline, Achwoka Dunstan, Mutugi Jamlick, Rakwar Joel, Wafula Andrew, Chabikuli Otto Nzapfurundi
FHI360, The Chancery, 2nd and 3rd Floor, Valley Road, Nairobi, Kenya.
FHI360, 2nd Floor, Block B, Hatfield Gardens, 333 Grosvenor Street, Hatfield, Pretoria, 0083, South Africa.
BMC Public Health. 2017 Feb 17;17(1):207. doi: 10.1186/s12889-017-4124-z.
Despite proven efficacy of the prevention mother-to-child transmission of HIV strategy, its adoption in Africa has remained slow. In Kenya, its effectiveness remain unknown. The aim of this study was to assess the effectiveness of a prevention of mother-to-child transmission program in Kenya.
This retrospective cross-sectional study analyzed 2,642 records of HIV-exposed infants who had a deoxyribonucleic acid polymerase chain reaction test done. The main outcome measure was HIV vertical transmission rates, stratified by i) infant age at diagnosis, ii) maternal prophylaxis and iii) infant mode of feeding. The characteristics of the infants who tested positive were compared to those who tested negative using Chi-square and Wilcoxon-Ranksum test. Bivariate and multivariate logistic regression analyses were conducted to establish associations and explore relationship between covariates and HIV transmission.
One thousand and one hundred nineteen (42.4%) infants had dried blood spot samples taken for HIV deoxyribonucleic acid polymerase chain reaction test within the first 6 weeks of age. Median age at diagnosis for HIV-positive infants was 4 months (IQR 1.5-9) while that of HIV-negative infants was 2 months (IQR 1.5-6). In total, 1,906 (72.1%) infants received prophylactic antiretrovirals. Infants whose mothers received prophylaxis had significantly lower vertical transmission rate (6.7%) compared to those whose mothers did not receive prophylaxis (24.0%), (OR 0.23, p < 0.001). When adjusted for feeding option and infant's age at diagnosis, the odds of transmission among women who received prophylaxis was 76% lower than that of women who did not receive any prophylaxis (OR 0.2 p < 0.001). 1,368 infants less than 6 months of age, 67.3%) were exclusively breastfed, 214 (10.5%) were replacement fed, and 164 (8.1%) mixed fed. Mixed feeding was associated with increased risk of HIV transmission (OR 2.7, p = 0.007). 67% of children older than 6 months were breastfed and had higher HIV transmission rate compared to those who were not breastfed (OR 2.3, p = 0.006).
The recorded rate of 9.3%, suggest the interventions implemented at the study sites were moderately effective, more so when provided early. Program performance will improve should the 12.8% of pregnant women who did not receive antiretroviral prophylaxis are reached.
尽管预防艾滋病母婴传播策略已被证实有效，但在非洲的采用速度仍然缓慢。在肯尼亚，其有效性尚不清楚。本研究的目的是评估肯尼亚预防艾滋病母婴传播项目的有效性。
这项回顾性横断面研究分析了2642例接受脱氧核糖核酸聚合酶链反应检测的艾滋病暴露婴儿的记录。主要结局指标是艾滋病垂直传播率，按以下因素分层：i）诊断时的婴儿年龄；ii）母亲的预防措施；iii）婴儿的喂养方式。使用卡方检验和威尔科克森秩和检验比较检测呈阳性和阴性婴儿的特征。进行二元和多变量逻辑回归分析以建立关联，并探讨协变量与艾滋病传播之间的关系。
1119名（42.4%）婴儿在出生后6周内采集了干血斑样本进行艾滋病脱氧核糖核酸聚合酶链反应检测。艾滋病阳性婴儿的诊断中位年龄为4个月（四分位间距1.5 - 9），而艾滋病阴性婴儿为2个月（四分位间距1.5 - 6）。总共有1906名（72.1%）婴儿接受了预防性抗逆转录病毒药物治疗。母亲接受预防措施的婴儿垂直传播率（6.7%）显著低于母亲未接受预防措施的婴儿（24.0%），（比值比0.23，p < 0.001）。在调整喂养方式和诊断时的婴儿年龄后，接受预防措施的女性传播几率比未接受任何预防措施的女性低76%（比值比0.2，p < 0.001）。1368名6个月以下婴儿（67.3%）纯母乳喂养，214名（10.5%）人工喂养，164名（8.1%）混合喂养。混合喂养与艾滋病传播风险增加相关（比值比2.7，p = 0.007）。6个月以上儿童中有67%进行母乳喂养，其艾滋病传播率高于未进行母乳喂养的儿童（比值比2.3，p = 0.006）。
记录的9.3%的传播率表明，在研究地点实施的干预措施具有一定效果，早期实施效果更佳。如果能覆盖到12.8%未接受抗逆转录病毒预防措施的孕妇，项目表现将会改善。
