马哈拉施特拉邦孟买一家三级护理医院十年来预防母婴传播项目的血清流行率及效果
Seroprevalence and Efficacy of Prevention of Parent to Child Transmission Program Over a Decade in a Tertiary Care Hospital in Mumbai, Maharashtra.
作者信息
Kapote Deepali Swapnil, Fonseca Michelle N, Nayak Arun Harishchandra, Vishwabharati Swathi H, Mohite Apeksha
机构信息
Department of Obstetrics and Gynaecology, Lokmanya Tilak Medical College, Mumbai, India.
出版信息
J Obstet Gynaecol India. 2021 Oct;71(5):501-509. doi: 10.1007/s13224-021-01428-7. Epub 2021 Apr 23.
BACKGROUND
Parent to child transmission is the major mode of spread of HIV. An effective national health program (PPTCT) has been designed under NACO which helps in reducing the spread of HIV by vertical transmission and improving the life of the women and her baby.
METHODS
A retrospective study was done at a tertiary care hospital, including pregnant women registered and delivered, and those who came directly in labour at the hospital during a period of 10 years from January 2010 to December 2019. Pretest counselling, HIV testing, Post-test counselling were done, and antiretroviral prophylaxis was given as per the NACP guidelines. Sociodemographic characteristics, obstetric outcome and efficacy of PPTCT services were analysed.
RESULTS
Out of the 63,947 antenatal mothers included, 61,061 (95.4%) accepted HIV testing. 177 of these tested positive (0.289%) with a significant reduction in the seroprevalence over the decade. Majority of seropositive women were primigravida; housewives from urban areas, from low income and educational background and with no history of any contraceptive use. Out of 718 live births, the MTCT rate was found to be 4.5% at 6 weeks over the whole decade and was noted to be 1.8 % at 18 months which is well within the goal of PPTCT program and hence elucidating the success. Seventy-four spouses of the 177 seropositive women tested positive, 55 tested negative and 49 did not undergo the HIV testing. Decline in the number of partners not undergoing testing was elicited. The discordant couple rate in the study was 31% and showed variable trend over the decade.
CONCLUSIONS
Our study has observed an overall increase in efficacy of PPTCT in terms of increased utilization of PPTCT through the decade, decrease in the vertical transmission and seroprevalence rate, increase in the acceptance rates of HIV testing by partner almost conquering the goal of NACO.
背景
母婴传播是艾滋病毒的主要传播方式。国家艾滋病控制组织（NACO）制定了一项有效的国家卫生计划（预防母婴传播计划，PPTCT），该计划有助于减少艾滋病毒的垂直传播，改善妇女及其婴儿的生活。
方法
在一家三级护理医院进行了一项回顾性研究，研究对象包括2010年1月至2019年12月这10年间登记并分娩的孕妇，以及直接到该医院分娩的孕妇。进行了检测前咨询、艾滋病毒检测、检测后咨询，并根据国家艾滋病控制规划（NACP）指南给予抗逆转录病毒预防治疗。分析了社会人口学特征、产科结局和预防母婴传播服务的效果。
结果
在纳入的63947名产前母亲中，61061名（95.4%）接受了艾滋病毒检测。其中177人检测呈阳性（0.289%），十年间血清阳性率显著下降。大多数血清阳性妇女为初产妇；来自城市地区、低收入和低教育背景且无任何避孕史的家庭主妇。在718例活产中，整个十年期间6周时的母婴传播率为4.5%，18个月时为1.8%，这完全在预防母婴传播计划的目标范围内，从而证明了该计划的成功。177名血清阳性妇女的74名配偶检测呈阳性，55名检测呈阴性，49名未接受艾滋病毒检测。未接受检测的伴侣数量有所下降。研究中的不一致伴侣率为31%，十年间呈不同趋势。
结论
我们的研究观察到，在过去十年中，预防母婴传播的效果总体有所提高——预防母婴传播的利用率增加、垂直传播和血清阳性率下降、伴侣对艾滋病毒检测的接受率提高，几乎达到了国家艾滋病控制组织的目标。
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