Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.
Victorian Centre for Biostatistics, Melbourne, Victoria, Australia.
BMC Public Health. 2020 Dec 7;20(1):1879. doi: 10.1186/s12889-020-09973-y.
Retention of HIV-infected mothers in integrated HIV and healthcare facilities is effective at reducing mother-to-child-transmission (MTCT) of HIV. In the context of Option B+, we examined maternal and HIV-exposed infant retention across three study arms to 18 months postpartum: mother-and-infant clinics (MIP), MIP with short-messaging service (MIP + SMS) and standard of care (SOC). In particular, we focused on the impact of mothers receiving an infant's HIV PCR test result on maternal and infant study retention.
A quantitative sub-study nested within a cluster randomised trial undertaken between May 2013 and August 2016 across 30 healthcare facilities in rural Malawi enrolling HIV-infected pregnant mothers and HIV-exposed infants on delivery, was performed. Survival probabilities of maternal and HIV-exposed infant study retention was estimated using Kaplan-Meier curves. Associations between mother's receiving an infant's HIV test result and in particular, an infant's HIV-positive result on maternal and infant study retention were modelled using time-varying multivariate Cox regression.
Four hundred sixty-one, 493, and 396 HIV-infected women and 386, 399, and 300 HIV-exposed infants were enrolled across study arms; MIP, MIP + SMS and SOC, respectively. A total of 47.5% of mothers received their infant's HIV test results < 5 months postpartum. Receiving an infant's HIV result by mothers was associated with a 70% increase in infant non-retention in the study compared with not receiving an infant's result (HR = 1.70; P-value< 0.001). Receiving a HIV-positive result was associated with 3.12 times reduced infant retention compared with a HIV-negative result (P-value< 0.001). Of the infants with a HIV-negative test result, 87% were breastfed at their final study follow-up.
Receiving an infant's HIV test result was a driving factor for reduced infant study retention, especially an infant's HIV-positive test result. As most HIV-negative infants were still breastfed at their last follow-up, this indicates a large proportion of HIV-exposed infants were potentially at future risk of MTCT of HIV via breastfeeding but were unlikely to undergo follow-up HIV testing after breastfeeding cessation. Future studies to identify and address underlying factors associated with infant HIV testing and reduced infant retention could potentially improve infant retention in HIV/healthcare facilities.
Pan African Clinical Trial Registry: PACTR201312000678196 .
将感染艾滋病毒的母亲纳入艾滋病毒综合医疗保健机构有助于减少母婴传播（MTCT）。在 B 方案+背景下，我们研究了在产后 18 个月内，三个研究组的母婴保留情况：母婴诊所（MIP）、MIP 加短信服务（MIP+SMS）和标准护理（SOC）。特别是，我们关注的是母亲收到婴儿 HIV PCR 检测结果对母婴研究保留的影响。
这是一项在马拉维农村地区的 30 家医疗保健机构进行的、在 2013 年 5 月至 2016 年 8 月期间开展的、以群组为基础的随机对照试验内的一个定量子研究。使用 Kaplan-Meier 曲线估计母婴研究保留的生存概率。利用时间变化的多变量 Cox 回归模型，分析母亲收到婴儿 HIV 检测结果（特别是婴儿 HIV 阳性结果）与母婴研究保留之间的关联。
研究组分别为 MIP、MIP+SMS 和 SOC，共纳入 461、493 和 396 名 HIV 感染的母亲和 386、399 和 300 名 HIV 暴露的婴儿。共有 47.5%的母亲在产后 5 个月内收到了婴儿的 HIV 检测结果。与未收到婴儿结果的母亲相比，收到婴儿结果的母亲中婴儿研究非保留率增加了 70%（HR=1.70；P<0.001）。收到 HIV 阳性结果与婴儿保留率降低 3.12 倍相关，而 HIV 阴性结果则相反（P<0.001）。在 HIV 检测结果为阴性的婴儿中，87%在最后一次研究随访时仍在母乳喂养。
收到婴儿的 HIV 检测结果是降低婴儿研究保留率的一个驱动因素，尤其是婴儿 HIV 阳性检测结果。由于大多数 HIV 阴性婴儿在最后一次随访时仍在母乳喂养，这表明很大一部分 HIV 暴露婴儿未来可能有通过母乳喂养传播 HIV 的风险，但在停止母乳喂养后不太可能接受 HIV 检测。未来的研究可以确定并解决与婴儿 HIV 检测和降低婴儿保留率相关的潜在因素，这可能会提高 HIV/医疗保健机构中婴儿的保留率。
泛非临床研究注册处：PACTR201312000678196 。
