Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
Center for Operational Research, International Union Against Tuberculosis and Lung disease (The Union), Paris, France.
BMC Pregnancy Childbirth. 2018 Dec 4;18(1):474. doi: 10.1186/s12884-018-2099-0.
Early initiation and longer duration of anti-retroviral therapy either as prophylaxis (pARV) or lifelong treatment (ART) in HIV-positive pregnant women prior to delivery has a huge impact in reducing mother to child transmission (MTCT) of HIV, maternal morbidity, mortality and increasing retention in care. In this study, we aimed to determine the following in a 'prevention of mother-to-child transmission' (PMTCT) programme in Central Women Hospital, Mandalay, Myanmar: i) uptake of ART and factors associated with the uptake ii) duration of ART/ pARV received by HIV-positive pregnant women prior to delivery, iii) factors associated with ART/ pARV initiation after delivery and iv) factors associated with shorter duration of ART/ pARV (≤ 8 weeks prior to delivery).
This was a retrospective cohort study using routinely collected data from PMTCT programme. We used multivariable Cox proportional Hazard model or log binomial models to assess the association between socio-demographic and clinical factors with a) uptake of ART/pARV, b) initiation of ART/pARV after delivery, c) shorter (≤8 weeks) duration of ART/PARV prior to delivery.
Of the 670 ART naïve HIV-positive women enrolled to PMTCT programme between March 2011 and December 2016, 588 (88%) were initiated on ART/pARV. In adjusted analysis, only pregnancy stage at enrolment was significantly associated with initiation of ART/pARV. Of 585 who had delivered babies on or before the censor date, 522 (89%) were on ART/pARV. Women who lived outside Mandalay were more likely to be initiated on ART after delivery (i.e., delayed ART initiation in those on ART). Among women who were initiated on ART/pARV before delivery (n = 468), only 59% got ART/pARV for > 8 weeks before delivery. Women whose spouses' HIV status was not recorded had 40% higher risk of short duration of ART/pARV.
This study shows high uptake of ART/pARV among those enrolled into the PMTCT programme. However, about one in eight pregnant women did not receive ART before delivery. Among those initiated on ART/pARV before delivery, nearly half of them received ART/pARV for less than 8 weeks prior to delivery. These aspects need to be improved in order to eliminate mother-to-child transmission of HIV.
在分娩前，为 HIV 阳性孕妇提供抗逆转录病毒治疗（ART）作为预防（pARV）或终身治疗（ART），无论是早期开始还是延长治疗时间，都可以大大降低母婴传播（MTCT）的风险，降低母婴发病率、死亡率，并提高母婴的保留率。在这项研究中，我们旨在确定缅甸曼德勒中央妇女医院的“预防母婴传播”（PMTCT）计划中的以下情况：i）接受 ART 的情况以及与接受 ART 相关的因素，ii）在分娩前接受 HIV 阳性孕妇的 ART/pARV 治疗时间，iii）分娩后开始 ART/pARV 的相关因素，iv）与 ART/pARV 治疗时间较短（<8 周）相关的因素。
这是一项回顾性队列研究，使用 PMTCT 计划中常规收集的数据。我们使用多变量 Cox 比例风险模型或对数二项式模型来评估社会人口统计学和临床因素与 a）接受 ART/pARV 治疗，b）分娩后开始 ART/pARV 治疗，c）分娩前接受 ART/pARV 治疗时间较短（<8 周）之间的关联。
在 2011 年 3 月至 2016 年 12 月期间，有 670 名接受 ART 治疗的 HIV 阳性孕妇参加了 PMTCT 计划，其中 588 名（88%）开始接受 ART/pARV 治疗。在调整分析中，只有入组时的妊娠阶段与开始接受 ART/pARV 治疗显著相关。在 585 名分娩婴儿的孕妇中，有 522 名（89%）正在接受 ART/pARV 治疗。居住在曼德勒以外地区的妇女更有可能在分娩后开始接受 ART 治疗（即，那些接受 ART 的妇女延迟了 ART 治疗）。在分娩前开始接受 ART/pARV 治疗的 468 名妇女中，只有 59%的人在分娩前接受了>8 周的 ART/pARV 治疗。配偶 HIV 状况未记录的妇女接受 ART/pARV 治疗的时间短的风险增加 40%。
这项研究表明，参加 PMTCT 计划的妇女接受 ART/pARV 的比例很高。然而，大约有八分之一的孕妇在分娩前没有接受 ART 治疗。在分娩前开始接受 ART/pARV 治疗的孕妇中，有近一半人在分娩前接受了不到 8 周的 ART/pARV 治疗。为了消除 HIV 的母婴传播，这些方面需要改进。
