Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America.
Global Health Innovations, Nairobi, Kenya.
PLoS One. 2020 May 29;15(5):e0232358. doi: 10.1371/journal.pone.0232358. eCollection 2020.
Kenya's guidelines for prevention of mother-to-child transmission of HIV (PMTCT) recommend routine viral load (VL) monitoring for pregnant and breastfeeding women.
We assessed PMTCT VL monitoring and clinical action occurring between last menstrual period (LMP) and 6 months postpartum at 4 Kenyan government hospitals. Pregnant women enrolled in the HIV Infant Tracking System from May 2016-March 2018 were included. We computed proportions who received VL testing within recommended timeframes and who received clinical action after unsuppressed VL result.
Of 424 participants, any VL testing was documented for 305 (72%) women and repeat VL testing was documented for 79 (19%). Only 115 women (27%) received a guideline-adherent baseline VL test and 27 (6%) received a guideline-adherent baseline and repeat VL test sequence. Return of baseline and repeat VL test results to the facility was high (average 96%), but patient notification of VL results was low (36% baseline and 49% repeat). Clinical action for unsuppressed VL results was even lower: 11 of 38 (29%) unsuppressed baseline results and 2 of 14 (14%) unsuppressed repeat results triggered clinical action.
Guideline-adherent VL testing and clinical intervention during PMTCT must be prioritized to improve maternal care and reduce the risk of HIV transmission to infants.
肯尼亚预防母婴传播艾滋病毒（PMTCT）指南建议对孕妇和哺乳期妇女进行常规病毒载量（VL）监测。
我们评估了肯尼亚 4 家政府医院在末次月经（LMP）和产后 6 个月之间的 PMTCT VL 监测和临床干预措施。2016 年 5 月至 2018 年 3 月期间，参加 HIV 婴儿跟踪系统的孕妇被纳入研究。我们计算了在推荐时间范围内接受 VL 检测的比例以及在 VL 结果未受抑制后接受临床干预的比例。
在 424 名参与者中，有 305 名（72%）女性接受了任何 VL 检测，79 名（19%）接受了重复 VL 检测。仅有 115 名女性（27%）接受了指南一致的基线 VL 检测，27 名（6%）接受了指南一致的基线和重复 VL 检测序列。将基线和重复 VL 检测结果返回给医疗机构的比例很高（平均 96%），但患者对 VL 结果的通知率较低（基线 36%，重复 49%）。未受抑制 VL 结果的临床干预措施更低：38 个未受抑制的基线结果中有 11 个（29%）和 14 个未受抑制的重复结果中有 2 个（14%）触发了临床干预。
PMTCT 期间必须优先考虑符合指南的 VL 检测和临床干预，以改善产妇护理，降低 HIV 向婴儿传播的风险。
