AIDS and TB Unit, Ministry of Health and Child Care, Government of Zimbabwe, Harare, Zimbabwe.
Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
PLoS One. 2019 Mar 13;14(3):e0212848. doi: 10.1371/journal.pone.0212848. eCollection 2019.
Despite high antiretroviral (ARV) treatment coverage among pregnant women for prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in Zimbabwe, the MTCT rate is still high. Therefore in 2016, the country adopted World Health Organization recommendations of stratifying pregnant women into "High" or"Low" MTCT risk for subsequent provision of HIV exposed infant (HEI) with appropriate follow-up care according to risk status.
The study sought to ascertain, among pregnant women who delivered in clinics of Harare in August 2017: the extent to which high risk MTCT pregnancies were identified at time of delivery; and whether their newborns were initiated on appropriate ARV prophylaxis, cotrimoxazole prophylaxis, subjected to early HIV diagnostic testing and initiated on ARV treatment.
Cross-sectional study using review of records of routinely collected program data.
Of the 1,786 pregnant women who delivered in the selected clinics, HIV status at the time of delivery was known for 1,756 (98%) of whom 197 (11%) were HIV seropositive. Only 19 (10%) could be classified as "high risk" for MTCT and the remaining 90% lacked adequate information to classify them into high or low risk for MTCT due to missing data. Of the 197 live births, only two (1%) infants had a nucleic-acid test (NAT) at birth and 32 (16%) infants had NAT at 6 weeks. Of all 197 infants, 183 (93%) were initiated on single ARV prophylaxis (Nevirapine), 15 (7%) infants' ARV prophylaxis status was not documented and one infant got dual ARV prophylaxis (Nevirapine+Zidovudine).
There was paucity of data requisite for MTCT risk stratification due to poor recording of data; "high risk" women were missed in the few circumstances where sufficient data were available. Thus "high risk" HEI are deprived of dual ARV prophylaxis and priority HIV NAT at birth and onwards which they require for PMTCT. Health workers need urgent training, mentorship and supportive supervision to master data management and perform MTCT risk stratification satisfactorily.
尽管津巴布韦为预防母婴传播艾滋病毒（HIV）而对孕妇进行了高抗逆转录病毒（ARV）治疗，但母婴传播率仍然很高。因此，2016 年，该国根据世界卫生组织的建议，将孕妇分为“高”或“低”母婴传播风险，以便根据风险状况为 HIV 暴露婴儿（HEI）提供适当的后续护理。
本研究旨在确定 2017 年 8 月在哈拉雷诊所分娩的孕妇中：分娩时识别高风险母婴传播妊娠的程度；以及他们的新生儿是否开始接受适当的 ARV 预防、复方磺胺甲噁唑预防、早期 HIV 诊断检测和开始 ARV 治疗。
使用常规收集的方案数据记录进行横断面研究。
在所选择的诊所中，1786 名孕妇中有 1756 名（98%）在分娩时已知 HIV 状况，其中 197 名（11%）为 HIV 阳性。只有 19 名（10%）可归类为母婴传播的“高风险”，而其余 90%因缺乏数据而无法将其归类为高或低风险。在 197 例活产中，只有 2 例（1%）婴儿在出生时进行了核酸检测（NAT），32 例（16%）婴儿在 6 周时进行了 NAT。在所有 197 例婴儿中，183 例（93%）开始接受单一 ARV 预防（奈韦拉平），15 例（7%）婴儿的 ARV 预防状况未记录，1 例婴儿接受双重 ARV 预防（奈韦拉平+齐多夫定）。
由于数据记录不良，缺乏母婴传播风险分层所需的数据；在极少数情况下，有足够的数据可用，但仍遗漏了“高风险”的妇女。因此，“高风险”的 HEI 被剥夺了他们所需的双重 ARV 预防和优先 HIV NAT 出生和出生后，这是他们进行 PMTCT 所必需的。卫生工作者需要紧急培训、指导和支持性监督，以掌握数据管理并充分进行母婴传播风险分层。
