在斯威士兰南部实施 B+方案以预防艾滋病毒母婴传播所面临的挑战和取得的成功。

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland.

机构信息

Médecins Sans Frontières, Mbabane, Swaziland.

London School of Hygiene and Tropical Medicine, London, UK.

出版信息

BMC Public Health. 2018 Mar 20;18(1):374. doi: 10.1186/s12889-018-5258-3.

DOI:10.1186/s12889-018-5258-3

PMID:29558896

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5859825/

Abstract

BACKGROUND

Universal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland.

METHODS

Lifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01-06/2013, mid: 07-12/2013 and late: 01-06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses.

RESULTS

Of 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (< 1000 copies/mL). Of 670 infants, 53.6% received an EID test, 320/359 had a test result recorded and of whom 7 (2.2%) were HIV+.

CONCLUSIONS

PMTCTB+ was found to be feasible in this setting, with high rates of maternal viral suppression and low transmission to the infant. High treatment attrition, poor follow-up of mother-baby pairs and under-utilisation of VL and EID testing are important programmatic challenges.

摘要

背景

在撒哈拉以南非洲的大多数国家，普遍为所有感染艾滋病毒的孕妇/哺乳期妇女提供抗逆转录病毒治疗（ART），即所谓的预防艾滋病毒母婴传播（PMTCT）B+方案（PMTCTB+），目前正在扩大规模。在向 PMTCTB+过渡期间，许多国家在实施艾滋病毒护理级联方面面临挑战。我们旨在描述在斯威士兰公共卫生部门实施 PMTCTB+方法的可行性。

方法

2013 年 1 月至 2014 年 6 月期间，在 9 个公共卫生设施中，为首次产前保健（ANC1）就诊时年龄≥16 岁的 HIV+孕妇提供终生 ART。研究登记期分为 3 个阶段（早期：2013 年 1 月至 6 月；中期：2013 年 7 月至 12 月；晚期：2014 年 1 月至 6 月），以说明时间趋势。应用 Kaplan-Meier 估计和 Cox 比例风险回归模型进行 ART 启动和流失分析。

结果

在 665 名 HIV+孕妇中，有 496 名（74.6%）开始接受 ART 治疗。在后期研究登记阶段，ART 启动率增加（中期：aHR：1.41；晚期：aHR：2.36），而 CD4≥500 时则降低（aHR：0.69）。24 个月时，有 52.9%的人留在护理中。流失与 ANC1 在第三孕期（aHR：2.37）、在二级保健机构就诊（aHR：1.98）和在后期登记阶段开始 ART 治疗（中期 aHR：1.48；晚期 aHR：1.67）相关。在 373 名符合条件的妇女中，有 67.3%接受了首次 VL 检测。251 名中有 223 名（88.8%）病毒载量得到抑制（<1000 拷贝/ml）。在 670 名婴儿中，有 53.6%接受了 EID 检测，有 320 名/359 名记录了检测结果，其中 7 名（2.2%）为 HIV+。