津巴布韦非本地妇女到产前诊所就诊是否会扭曲该国孕妇艾滋病毒流行率监测估计值？

Does nonlocal women's attendance at antenatal clinics distort HIV prevalence surveillance estimates in pregnant women in Zimbabwe?

作者信息

Wilson Katherine C, Mhangara Mutsa, Dzangare Janet, Eaton Jeffrey W, Hallett Timothy B, Mugurungi Owen, Gregson Simon

机构信息

aDepartment of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, W2 1PG, UK bAIDS and TB Department, Zimbabwe Ministry of Health and Child Care cBiomedical Research and Training Institute, Harare, Zimbabwe.

出版信息

AIDS. 2017 Apr;31 Suppl 1(Suppl 1):S95-S102. doi: 10.1097/QAD.0000000000001337.

DOI:10.1097/QAD.0000000000001337

PMID:28296805

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5677598/

Abstract

OBJECTIVE

The objective was to assess whether HIV prevalence measured among women attending antenatal clinics (ANCs) are representative of prevalence in the local area, or whether estimates may be biased by some women's choice to attend ANCs away from their residential location. We tested the hypothesis that HIV prevalence in towns and periurban areas is underestimated in ANC sentinel surveillance data in Zimbabwe.

METHODS

National unlinked anonymous HIV surveillance was conducted at 19 ANCs in Zimbabwe in 2000, 2001, 2002, 2004, 2006, 2009, and 2012. This data was used to compare HIV prevalence and nonlocal attendance levels at ANCs at city, town, periurban, and rural clinics in aggregate and also for individual ANCs.

RESULTS

In 2000, HIV prevalence at town ANCs (36.6%, 95% CI 34.4-38.9%) slightly underestimated prevalence among urban women attending these clinics (40.7%, 95% CI 37.6-43.9%). However, there was no distortion in HIV prevalence at either the aggregate clinic location or at individual clinics in more recent surveillance rounds. HIV prevalence was consistently higher in towns and periurban areas than in rural areas. Nonlocal attendance was high at town (26-39%) and periurban (53-95%) ANCs but low at city clinics (<10%). However, rural women attending ANCs in towns and periurban areas had higher HIV prevalence than rural women attending rural clinics, and were younger, more likely to be single, and less likely to be housewives.

CONCLUSIONS

In Zimbabwe, HIV prevalence among ANC attendees provides reliable estimates of HIV prevalence in pregnant women in the local area.

摘要

目的

评估在产前诊所（ANC）就诊的女性中所测得的艾滋病毒流行率是否代表当地的流行率，或者估计值是否会因一些女性选择前往非居住地的产前诊所就诊而产生偏差。我们检验了这样一个假设：在津巴布韦，产前诊所哨点监测数据低估了城镇和城郊地区的艾滋病毒流行率。

方法

2000年、2001年、2002年、2004年、2006年、2009年和2012年在津巴布韦的19家产前诊所开展了全国性非关联匿名艾滋病毒监测。该数据用于总体比较城市、城镇、城郊和农村诊所产前诊所的艾滋病毒流行率及非本地就诊水平，也用于各单个产前诊所的比较。

结果

2000年，城镇产前诊所的艾滋病毒流行率（36.6%，95%可信区间34.4 - 38.9%）略低于在这些诊所就诊的城市女性中的流行率（40.7%，95%可信区间37.6 - 43.9%）。然而，在最近几轮监测中，无论是总体诊所地点还是单个诊所，艾滋病毒流行率均无偏差。城镇和城郊地区的艾滋病毒流行率一直高于农村地区。城镇（26 - 39%）和城郊（53 - 95%）产前诊所的非本地就诊率较高，但城市诊所的非本地就诊率较低（<10%）。然而，在城镇和城郊地区产前诊所就诊的农村女性的艾滋病毒流行率高于在农村诊所就诊的农村女性，且更年轻，更可能单身，不太可能是家庭主妇。