Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Trop Med Int Health. 2021 Feb;26(2):173-183. doi: 10.1111/tmi.13518. Epub 2020 Nov 23.
Mother-child pairs may separate during early life, yet the health impacts thereof are unclear. We explored the patterns and impact of separation among women living with HIV (WLHIV) and their children in South Africa.
WLHIV who had initiated antiretroviral therapy (ART) during pregnancy received HIV viral load (VL) testing and completed a timeline questionnaire of mother-child separation since delivery at 3-5 years post-partum. Health care usage was abstracted from routine medical records. We examined associations between separation and (a) maternal health outcomes (engagement in HIV care and HIV viral suppression, [VS]) and (b) child health outcomes (post-breastfeeding HIV testing and immunisation completion), using logistic regression.
Of 346 mother-child pairs (median maternal age at antenatal ART initiation, 28 years), 24% were ever separated (median time to first separation 20 months, interquartile range [IQR] 9, 31). Most separated children were living with their grandmothers (65/83, 78%). Mothers who ever separated were younger, and more likely to be employed, and to reside in informal housing than those who never separated. Any separation reduced the odds of VS ≤ 50 copies/mL at four years post-partum (odds ratio 0.57; 95% CI 0.34-0.93); associations were similar for VL ≤ 1000 copies/mL and maternal engagement in care. No association was found between separation and child confirmatory HIV testing or immunisation completion.
In this setting, mother-child separation is common in the first four years of life and appears associated with suboptimal maternal outcomes. Further research is required to understand the drivers and implications of mother-child separation.
母婴可能在生命早期就分离，但这种分离对健康的影响尚不清楚。我们探讨了南非感染艾滋病毒的妇女（WLHIV）及其子女的分离模式和影响。
在怀孕期间开始接受抗逆转录病毒治疗（ART）的 WLHIV 在产后 3-5 年内接受 HIV 病毒载量（VL）检测，并完成了一份关于母婴分离的时间线问卷。从常规医疗记录中提取了医疗保健使用情况。我们使用逻辑回归检验了分离与（a）母婴健康结局（参与 HIV 护理和 HIV 病毒抑制[VS]）和（b）儿童健康结局（母乳喂养后 HIV 检测和免疫接种完成）之间的关联。
在 346 对母婴（中位年龄为 28 岁）中，24%曾经历过分离（中位数首次分离时间为 20 个月，四分位距[IQR] 9，31）。大多数分离的孩子与他们的祖母住在一起（65/83，78%）。曾经分离的母亲更年轻，更有可能就业，更有可能居住在非正规住房中，而不是从未分离的母亲。任何分离都降低了产后四年时 VS≤50 拷贝/mL 的可能性（优势比 0.57；95%CI 0.34-0.93）；对于 VL≤1000 拷贝/mL 和母亲参与护理的情况，也存在类似的关联。分离与儿童确认 HIV 检测或免疫接种完成之间没有关联。
在这种情况下，母婴分离在生命的头四年很常见，似乎与产妇结局不佳有关。需要进一步研究以了解母婴分离的驱动因素和影响。
