Moyo F, Haeri Mazanderani A, Bhardwaj S, Mhlongo O B, Kufa T, Ng'oma K, Smith B A, Sherman G G
Paediatric HIV Diagnostics, Wits Health Consortium, Johannesburg, South Africa; Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2018 Mar 28;108(4):319-324. doi: 10.7196/SAMJ.2017.v108i4.12630.
Identifying and addressing gaps in the prevention of mother-to-child transmission of HIV (PMTCT) is required if South Africa (SA) is to achieve targets for eliminating MTCT (eMTCT). Potential PMTCT gaps that increase MTCT risk include late maternal HIV diagnosis, lack of or delayed antiretroviral therapy (ART) during pregnancy and breastfeeding, and lack of effective prophylaxis for HIV-exposed infants.
To investigate, in near real time, PMTCT gaps among HIV-infected infants in three districts of KwaZulu-Natal Province, SA.
Between May and September 2016, PMTCT co-ordinators from eThekwini, uMgungundlovu and uMkhanyakude districts received daily email notification of all HIV polymerase chain reaction (PCR)-positive results. Co-ordinators reviewed facility records for each infant to identify gaps in PMTCT care, including maternal age, timing of maternal HIV diagnosis, maternal treatment history and maternal viral load (VL) monitoring. Data were submitted via the mobile phone SMS (text message) service using Rapid Pro technology and analysed in Stata 14.
Data on PMTCT gaps were received for 367 (91.8%) of 400 infants with HIV PCR-positive results, within a median time of 12.5 days (interquartile range (IQR) 6 - 23). The median maternal age was 25 years (IQR 22 - 30), with 48 teenage mothers (15 - 19 years). The sample size was too small to determine whether there were significant differences in PMTCT gaps between the 48 teenage mothers and 293 older (20 - 34 years) mothers. Of the mothers, 220 (60.0%) were first diagnosed prior to conception or at their first antenatal care (ANC) visit, and 127 (34.6%) at or after delivery; 137 (37.3%) transmitted HIV to their infants despite receiving >12 weeks of ART. VL results were unavailable for 70.0% of women. Only 41 (17.5%) of women known to be HIV-positive during ANC had confirmed virological suppression. No statistically significant differences in PMTCT gaps were observed between districts, owing to small sample sizes in uMgungundlovu and uMkhanyakude.
The findings highlight the need to improve services during ANC, in particular prioritising maternal VL monitoring. We intend to use improved technology to streamline data collection and reporting towards eMTCT.
如果南非要实现消除母婴传播艾滋病毒（eMTCT）的目标，就需要识别并解决预防母婴传播艾滋病毒（PMTCT）方面的差距。增加母婴传播风险的潜在PMTCT差距包括孕产妇艾滋病毒诊断延迟、孕期和哺乳期抗逆转录病毒疗法（ART）缺乏或延迟，以及对艾滋病毒暴露婴儿缺乏有效的预防措施。
近乎实时地调查南非夸祖鲁-纳塔尔省三个地区感染艾滋病毒婴儿的PMTCT差距。
2016年5月至9月期间，德班、乌姆贡古德洛武和乌姆卡尼亚库德地区的PMTCT协调员每天收到所有艾滋病毒聚合酶链反应（PCR）阳性结果的电子邮件通知。协调员查阅每个婴儿的机构记录，以确定PMTCT护理方面的差距，包括产妇年龄、孕产妇艾滋病毒诊断时间、孕产妇治疗史和孕产妇病毒载量（VL）监测。数据通过使用Rapid Pro技术的手机短信服务提交，并在Stata 14中进行分析。
在400例艾滋病毒PCR检测呈阳性的婴儿中，有367例（91.8%）收到了PMTCT差距数据，中位时间为12.5天（四分位间距（IQR）6 - 23）。孕产妇中位年龄为25岁（IQR 22 - 30），有48名青少年母亲（15 - 19岁）。样本量太小，无法确定48名青少年母亲和293名年龄较大（20 - 34岁）母亲在PMTCT差距方面是否存在显著差异。在这些母亲中，220例（60.0%）在受孕前或首次产前检查（ANC）时首次被诊断出感染艾滋病毒，127例（34.6%）在分娩时或分娩后被诊断出感染；137例（37.3%）尽管接受了超过12周的抗逆转录病毒治疗，但仍将艾滋病毒传播给了婴儿。70.0%的女性没有病毒载量检测结果。在ANC期间已知感染艾滋病毒的女性中，只有41例（17.5%）确认病毒学得到抑制。由于乌姆贡古德洛武和乌姆卡尼亚库德地区的样本量较小，各地区在PMTCT差距方面未观察到统计学上的显著差异。
研究结果凸显了在ANC期间改善服务的必要性，特别是要优先进行孕产妇病毒载量监测。我们打算使用改进的技术来简化数据收集和报告工作，以实现eMTCT。
