迈向卢旺达消除母婴传播艾滋病毒：病例对照研究母婴传播的危险因素
Towards elimination of mother-to-child transmission of HIV in Rwanda: a nested case-control study of risk factors for transmission.
机构信息
Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda.
Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
出版信息
BMC Pregnancy Childbirth. 2021 Apr 28;21(1):339. doi: 10.1186/s12884-021-03806-5.
BACKGROUND
Mother-to-child HIV transmission (MTCT) has substantially declined since the scale-up of prevention programs around the world, including Rwanda. To achieve full elimination of MTCT, it is important to understand the risk factors associated with residual HIV transmission, defined as MTCT at the population-level that still occurs despite universal access to PMTCT.
METHODS
We performed a case control study of children born from mothers with HIV with known vital status at 18 months from birth, who were followed in three national cohorts between October and December 2013, 2014, and 2015 in Rwanda. Children with HIV were matched in a ratio of 1:2 with HIV-uninfected children and a conditional logistic regression model was used to investigate risk factors for MTCT.
RESULTS
In total, 84 children with HIV were identified and matched with 164 non-infected children. The median age of mothers from both groups was 29 years (interquartile range (IQR): 24-33). Of these mothers, 126 (51.4 %) initiated antiretroviral therapy (ART) before their pregnancy on record. In a multivariable regression analysis, initiation of ART in the third trimester (Adjusted Odds Ratio [aOR]: 9.25; 95 % Confidence Interval [95 % CI]: 2.12-40.38) and during labour or post-partum (aOR: 8.87; 95 % CI: 1.92-40.88), compared to initiation of ART before pregnancy, increased the risk of MTCT. Similarly, offspring of single mothers (aOR: 7.15; 95 % CI: 1.15-44.21), and absence of postpartum neonatal ART prophylaxis (aOR: 7.26; 95 % CI: 1.66-31.59) were factors significantly associated with MTCT.
CONCLUSIONS
Late ART initiation for PMTCT and lack of postpartum infant prophylaxis are still the most important risk factors to explain MTCT in the era of universal access. Improved early attendance at antenatal care, early ART initiation, and enhancing the continuum of care especially for single mothers is crucial for MTCT elimination in Rwanda.
背景
自全球范围内扩大预防方案以来，母婴 HIV 传播（MTCT）已大幅下降，包括卢旺达。为了实现 MTCT 的完全消除，了解与残留 HIV 传播相关的风险因素至关重要，残留 HIV 传播定义为尽管普遍获得了 PMTCT，但人群层面仍发生的 MTCT。
方法
我们对在 2013 年 10 月至 12 月、2014 年和 2015 年期间在卢旺达的三个全国队列中出生时已知生存状态的 HIV 阳性母亲所生的儿童进行了病例对照研究。将 HIV 阳性儿童与 HIV 阴性儿童以 1:2 的比例进行匹配，并使用条件逻辑回归模型来调查 MTCT 的风险因素。
结果
共发现 84 名 HIV 阳性儿童，并与 164 名未感染儿童相匹配。两组母亲的中位年龄均为 29 岁（四分位距（IQR）：24-33）。这些母亲中有 126 名（51.4%）在记录的妊娠前开始接受抗逆转录病毒治疗（ART）。在多变量回归分析中，与妊娠前开始 ART 相比，妊娠晚期（调整后的优势比[aOR]：9.25；95%置信区间[95%CI]：2.12-40.38）和分娩时或产后（aOR：8.87；95%CI：1.92-40.88）开始 ART 增加了 MTCT 的风险。同样，单身母亲的子女（aOR：7.15；95%CI：1.15-44.21）和产后新生儿 ART 预防措施缺失（aOR：7.26；95%CI：1.66-31.59）也是与 MTCT 显著相关的因素。
结论
在普遍获得 PMTCT 的时代，晚期开始 ART 进行 PMTCT 以及缺乏产后婴儿预防措施仍然是解释 MTCT 的最重要的风险因素。改善早期产前保健就诊、早期开始 ART 以及加强连续性护理，特别是为单身母亲提供护理，对于卢旺达消除 MTCT 至关重要。
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