基于社区的预防母婴传播和艾滋病毒暴露儿童死亡率指标在莫桑比克农村。
Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique.
机构信息
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
Barcelona Institute for Global Health, Barcelona, Spain.
出版信息
BMC Public Health. 2021 Mar 17;21(1):520. doi: 10.1186/s12889-021-10568-4.
BACKGROUND
Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally..
METHODS
A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017-April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model.
RESULTS
Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8-39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1-5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death.
CONCLUSIONS
In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates.
背景
消除母婴传播（EMTCT）意味着新的儿科 HIV 感染病例率目标<50/100,000 活产，传播率<5%。我们在莫桑比克的社区层面评估了这些指标，在全球范围内，母婴传播是第二高的。
方法
在莫桑比克马希齐健康人口监测系统中进行了一项横断面家庭调查（2017 年 10 月至 2018 年 4 月）。随机选择前 4 年的活产儿，并通过记录或适龄检测确定母婴 HIV 状况。对于 HIV 状况缺失的参与者，采用多重插补链方程（MICE）进行调整，以估计流行率和传播率。采用 Fine-Gray 模型估计回顾性累积死亡率和危险因素。
结果
在 5000 名选定的母婴对中，有 3486 名同意参与。经 MICE 调整后，社区中母亲的 HIV 流行率估计为 37.6%（95%CI：35.8-39.4%）。年龄<19 岁的青少年中，估计值翻了一番（从 8.0%增至 19.1%），年龄<25 岁的母亲增加了 1.5 倍。在研究时，总体调整后的垂直 HIV 传播率在 HIV 暴露儿童（HEC）中为 4.4%（95%CI：3.1-5.7%）。儿科病例感染率估计为 1654/100,000 活产。HEC 的检测覆盖率接近 96.0%；然而，只有 69.1%的人在<2 个月大时进行了早期检测。累积儿童死亡率为 41.6/1000 活产。HIV 阳性状态和较晚的出生顺序与死亡显著相关。新生儿并发症、HIV 和肺炎是儿科死亡的主要原因。
结论
在莫桑比克，SPECTRUM 模型估计的母婴传播率为 15%，高于我们基于社区的 HIV 暴露儿童母婴传播率的估计值。需要对 EMTCT 进展进行基于社区的次国家级评估，以补充诊所和模型估计。
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