Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
BMC Public Health. 2021 Sep 21;21(1):1710. doi: 10.1186/s12889-021-11742-4.
Eliminating mother-to-child transmission of HIV (MTCT) in sub-Saharan Africa is hindered by limited understanding of HIV-testing and HIV-care engagement among pregnant and breastfeeding women.
We investigated HIV-testing and HIV-care engagement during pregnancy and breastfeeding from 2014 to 2018 in the Agincourt Health and Demographic Surveillance System (HDSS). We linked HIV patient clinic records to HDSS pregnancy data. We modelled time to a first recorded HIV-diagnosis following conception, and time to antiretroviral therapy (ART) initiation following diagnosis using Kaplan-Meier methods. We performed sequence and cluster analyses for all pregnancies linked to HIV-related clinic data to categorise MTCT risk period engagement patterns and identified factors associated with different engagement patterns using logistic regression. We determined factors associated with ART resumption for women who were lost to follow-up (LTFU) using Cox regression.
Since 2014, 15% of 10,735 pregnancies were recorded as occurring to previously (51%) or newly (49%) HIV-diagnosed women. New diagnoses increased until 2016 and then declined. We identified four MTCT risk period engagement patterns (i) early ART/stable care (51.9%), (ii) early ART/unstable care (34.1%), (iii) late ART initiators (7.6%), and (iv) postnatal seroconversion/early, stable ART (6.4%). Year of delivery, mother's age, marital status, and baseline CD4 were associated with these patterns. A new pregnancy increased the likelihood of treatment resumption following LTFU.
Almost half of all pregnant women did not have optimal ART coverage during the MTCT risk period. Programmes need to focus on improving retention, and leveraging new pregnancies to re-engage HIV-positive women on ART.
在撒哈拉以南非洲，消除艾滋病毒母婴传播（MTCT）受到阻碍，原因是对孕妇和哺乳期妇女的 HIV 检测和 HIV 护理参与情况了解有限。
我们调查了 2014 年至 2018 年在阿格因库尔健康和人口监测系统（HDSS）中怀孕期间和哺乳期的 HIV 检测和 HIV 护理参与情况。我们将 HIV 患者的临床记录与 HDSS 妊娠数据相关联。我们使用 Kaplan-Meier 方法对受孕后首次记录的 HIV 诊断和诊断后开始抗逆转录病毒治疗（ART）的时间进行建模。我们对所有与 HIV 相关临床数据相关联的妊娠进行序列和聚类分析，对 MTCT 风险期参与模式进行分类，并使用逻辑回归分析确定与不同参与模式相关的因素。我们使用 Cox 回归确定对失访（LTFU）妇女恢复 ART 的相关因素。
自 2014 年以来，10735 例妊娠中有 15%记录为先前（51%）或新诊断（49%）HIV 诊断的妇女所怀。新诊断数量直到 2016 年才增加，然后下降。我们确定了四种 MTCT 风险期参与模式（i）早期 ART/稳定护理（51.9%），（ii）早期 ART/不稳定护理（34.1%），（iii）晚期 ART 启动者（7.6%）和（iv）产后血清转换/早期稳定 ART（6.4%）。分娩年份、母亲年龄、婚姻状况和基线 CD4 与这些模式相关。再次怀孕增加了 LTFU 后恢复治疗的可能性。
几乎一半的孕妇在 MTCT 风险期内没有获得最佳的 ART 覆盖。方案需要重点关注提高保留率，并利用新的怀孕机会，让 HIV 阳性妇女重新接受 ART。
