Department of Women Health Care, Hunan Provincial Maternal and Child Health Hospital, Hunan, China.
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China.
Women Birth. 2019 Dec;32(6):570-578. doi: 10.1016/j.wombi.2018.11.004. Epub 2018 Nov 26.
China is the first country to initiate a nationwide program for prevention of mother-to-child transmission of human immunodeficiency virus, syphilis and hepatitis B virus by an integrated approach. However, the progress of this program remains unreported at national or local level for China. Therefore, we performed a hospital-based longitudinal study to assess the integrated prevention effect in Hunan, South-central China.
This study was conducted at 123 counties in Hunan and covered all local hospitals providing midwifery and antenatal care services from 2010 to 2016. We used the Cochran-Armitage test to examine the temporal changes of the indicators related with prevention of mother-to-child transmission. Besides, we used Spearman rank correlation analysis to assess the association between mother-to-child transmission rates and the process indicators related with prevention of mother-to-child transmission.
After implementation of integrated prevention program, the indicators related with prevention of mother-to-child transmission are moving in the right direction. From 2010 to 2016, mother-to-child transmission rates significantly decreased from 19.4% to 9.6% for human immunodeficiency virus, and from 116.3 to 13.6 cases per 100,000 live births for syphilis. The proportion of children receiving hepatitis B immunoglobulin injection within 24h after birth increased from 95.2% to 98.9% among exposed neonates. Mother-to-child transmission rates were negatively associated with the process indicators related with prevention of mother-to-child transmission (all P<0.05).
Our prevention program of mother-to-child transmission for three diseases by an integrated approach proved to be viable and effective. Our model may be of interest to other countries.
中国是第一个采用综合方法开展预防艾滋病母婴传播、梅毒和乙型肝炎母婴传播全国性项目的国家。然而，中国在国家或地方层面都没有报告该项目的进展情况。因此，我们进行了一项基于医院的纵向研究，以评估该项目在中国中南地区的综合预防效果。
该研究在湖南的 123 个县进行，覆盖了 2010 年至 2016 年期间所有提供助产和产前保健服务的当地医院。我们使用 Cochran-Armitage 检验来检验与预防母婴传播相关的指标的时间变化。此外，我们使用 Spearman 秩相关分析来评估母婴传播率与预防母婴传播相关的过程指标之间的关联。
在实施综合预防计划后，与预防母婴传播相关的指标朝着正确的方向发展。2010 年至 2016 年期间，艾滋病母婴传播率从 19.4%显著下降至 9.6%，梅毒母婴传播率从每 10 万活产儿 116.3 例下降至 13.6 例。乙肝免疫球蛋白注射率从 95.2%提高至 98.9%。母婴传播率与预防母婴传播相关的过程指标呈负相关（均 P<0.05）。
我们采用综合方法预防三种疾病母婴传播的项目是可行且有效的。我们的模式可能会引起其他国家的兴趣。
