Hauser Blake M, Miller William C, Tweya Hannock, Speight Colin, Mtande Tiwonge, Phiri Sam, Ball L M, Hosseinipour Mina C, Hoffman Irving F, Rosenberg Nora E
1 Department of Environmental Sciences and Engineering, 2331 University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
2 Department of Medicine, 2331 University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
Int J STD AIDS. 2018 Feb;29(2):185-194. doi: 10.1177/0956462417721658. Epub 2017 Jul 27.
Malawi launched Option B+, a program for all pregnant or breastfeeding HIV-positive women to begin lifelong combination antiretroviral therapy (cART), in July 2011. This study characterises a portion of the continuum of care within an antenatal setting in Lilongwe. Women testing HIV-positive and having a cART initiation record at Bwaila Antenatal Clinic from July 2013 to January 2014 were included. Using logistic regression models, we analysed relationships between maternal characteristics and return for infant testing. Among 490 HIV-positive women with a cART initiation record, 360 (73%) were retained at three months. Of these, 203 (56%) were adherent. Records of infant testing were located for 204 women (42%). Women who were not retained were less likely to have an early infant diagnosis record (aOR = 0.20; 95% CI: 0.10, 0.41). Among the women retained, there was a non-significant association between maternal adherence and infant testing (OR = 1.35; 95% CI: 0.89, 2.06). Women lost at earlier continuum stages, who are at higher risk for mother-to-child-transmission, were less likely to bring infants for testing. Even with a test-and-treat program, many women did not remain in care or bring their infant for testing. Facilitating strategies to improve these measures remains an important unmet need.
马拉维于2011年7月启动了“选项B+”项目，该项目面向所有怀孕或正在哺乳的艾滋病毒呈阳性的妇女，让她们开始接受终身联合抗逆转录病毒疗法（cART）。本研究描述了利隆圭一家产前机构内连续护理过程中的一部分情况。纳入了2013年7月至2014年1月期间在布瓦伊拉产前诊所艾滋病毒检测呈阳性且有cART起始记录的妇女。我们使用逻辑回归模型分析了产妇特征与婴儿检测回访之间的关系。在490名有cART起始记录的艾滋病毒呈阳性妇女中，360名（73%）在三个月时仍在接受护理。其中，203名（56%）坚持治疗。找到了204名妇女（42%）的婴儿检测记录。未继续接受护理的妇女不太可能有早期婴儿诊断记录（调整后比值比=0.20；95%置信区间：0.10，0.41）。在继续接受护理的妇女中，产妇坚持治疗与婴儿检测之间没有显著关联（比值比=1.35；95%置信区间：0.89，2.06）。在连续护理早期阶段失访的妇女，母婴传播风险更高，她们带婴儿进行检测的可能性较小。即使有检测和治疗项目，许多妇女仍未继续接受护理或带婴儿进行检测。制定促进措施以改善这些指标仍是一项重要的未满足需求。
