巴西的母婴传播艾滋病毒：来自“巴西出生研究”的数据，一项基于全国医院的研究。
Mother to child transmission of HIV in Brazil: Data from the "Birth in Brazil study", a national hospital-based study.
作者信息
Domingues Rosa Maria Soares Madeira, Saraceni Valeria, Leal Maria do Carmo
机构信息
Laboratório de Pesquisa Clínica em DS/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Coordenação de Análise da Situação em Saúde, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.
出版信息
PLoS One. 2018 Feb 13;13(2):e0192985. doi: 10.1371/journal.pone.0192985. eCollection 2018.
AIMS
to estimate the mother to child transmission (MTCT) of HIV among infected pregnant women identified in the "Birth in Brazil" study and to evaluate care practices provided in order to identify missed opportunities at preventing the MTCT of HIV infection in the country.
METHODS
Descriptive study using data obtained from the consultation of different databases: the "Birth in Brazil" study database and the Brazilian National Information Systems (NIS) databases. We used cases of pregnant women infected with HIV identified in the "Birth in Brazil" study, and cases of AIDS in children under 5 years old identified in the NIS, to estimate the MTCT of HIV infection in the country, with a 95% confidence interval. We also estimated the HIV cascade (HIV diagnosis; use of antiretroviral treatment (ART) during pregnancy, labour, and for the newborn; adequate care during childbirth considering viral load at birth; and no breastfeeding) using data from the same sources.
RESULTS
MTCT of HIV of 2.0% (95% CI 0.3%-13.8%). At birth, 84.0% of HIV infected woman showed a positive HIV diagnosis, 74.9% received combined ART during pregnancy, 80.7% received ART during childbirth, 77.1% received adequate care during childbirth, 86.8% of newborns received ART within the first 24 hours after birth, and 2.8% of newborns were breastfed. Considering all steps, 61.3% of the women (95% CI 48.3%-72.8%) received all available medical interventions. In the analysis restricted to women identified in the NIS, 65.3% (95% CI 48.0%-79.3%) of HIV infected women received all available medical interventions.
CONCLUSION
Brazil has healthcare policies that guarantee free access to tests, ART and substitutes for maternal milk. However, missed opportunities to prevent MTCT of HIV were identified in at least one-third of women and may be making it difficult to reach HIV-elimination targets especially in the less developed country regions.
目的
评估在“巴西出生”研究中确诊的感染艾滋病毒的孕妇的母婴传播（MTCT）情况，并评估所提供的护理措施，以确定该国在预防艾滋病毒感染母婴传播方面存在的错失机会。
方法
采用描述性研究，数据来自不同数据库的查询：“巴西出生”研究数据库和巴西国家信息系统（NIS）数据库。我们使用“巴西出生”研究中确诊的感染艾滋病毒的孕妇病例，以及NIS中确诊的5岁以下儿童艾滋病病例，以估计该国艾滋病毒感染的母婴传播情况，并给出95%置信区间。我们还使用相同来源的数据估计艾滋病毒诊疗流程（艾滋病毒诊断；孕期、分娩期及新生儿期使用抗逆转录病毒治疗（ART）；考虑出生时病毒载量的分娩期充分护理；以及不进行母乳喂养）。
结果
艾滋病毒母婴传播率为2.0%（95%置信区间0.3%-13.8%）。分娩时，84.0%感染艾滋病毒的女性艾滋病毒诊断呈阳性，74.9%在孕期接受了联合抗逆转录病毒治疗，80.7%在分娩时接受了抗逆转录病毒治疗，77.1%在分娩时接受了充分护理，86.8%的新生儿在出生后24小时内接受了抗逆转录病毒治疗，2.8%的新生儿进行了母乳喂养。考虑所有步骤，61.3%的女性（95%置信区间48.3%-72.8%）接受了所有可用的医疗干预措施。在仅限于NIS中确诊的女性的分析中，65.3%（95%置信区间48.0%-79.3%）感染艾滋病毒的女性接受了所有可用的医疗干预措施。
结论
巴西拥有保障免费进行检测、提供抗逆转录病毒治疗和母乳替代品的医疗政策。然而，至少三分之一的女性存在预防艾滋病毒母婴传播的错失机会，这可能使得实现消除艾滋病毒目标变得困难，尤其是在该国较不发达的地区。
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