Department of Epidemiology & Biostatistics, City University of New York (CUNY) Graduate School of Public Health & Health Policy, 55 W125th Street, Room 543, New York, NY, 10025, USA.
ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA.
BMC Pregnancy Childbirth. 2022 Mar 15;22(1):208. doi: 10.1186/s12884-022-04527-z.
Pregnant and breastfeeding adolescents and young women living with HIV (AYWLH) have lower retention in prevention of mother-to-child transmission (PMTCT) services compared to older women.
We evaluated a differentiated service model for pregnant and postnatal AYWLH at seven health facilities in western Kenya aimed at improving retention in antiretroviral treatment (ART) services. All pregnant AYWLH < 25 years presenting for antenatal care (ANC) were invited to participate in group ANC visits including self-care and peer-led support sessions conducted by health facility nurses per national guidelines. ART register data were used to assess loss to follow-up (LTFU) among newly-enrolled pregnant adolescent (< 20 years) and young women (20-24 years) living with HIV starting ART in the pre-period (January-December 2016) and post-period (during implementation; December 2017-January 2019). Poisson regression models compared LTFU incidence rate ratios (IRR) in the first six months after PMTCT enrollment and risk ratios compared uptake of six week testing for HIV-exposed infants (HEI) between the pre- and post-periods.
In the pre-period, 223 (63.2%) of 353 pregnant AYWLH newly enrolled in ANC had ART data, while 320 (71.1%) of 450 in the post-period had ART data (p = 0.02). A higher proportion of women in the post-period (62.8%) had known HIV-positive status at first ANC visit compared to 49.3% in the pre-period (p < 0.001). Among pregnant AYWLH < 20 years, the incidence rate of LTFU in the first six months after enrollment in ANC services declined from 2.36 per 100 person months (95%CI 1.06-5.25) in the pre-period to 1.41 per 100 person months (95%CI 0.53-3.77) in the post-period. In both univariable and multivariable analysis, AYWLH < 20 years in the post-period were almost 40% less likely to be LTFU compared to the pre-period, although this finding did not meet the threshold for statistical significance (adjusted incidence rate ratio 0.62, 95%CI 0.38-1.01, p = 0.057). Testing for HEI was 10% higher overall in the post-period (adjusted risk ratio 1.10, 95%CI 1.01-1.21, p = 0.04).
Interventions are urgently needed to improve outcomes among pregnant and postnatal AYWLH. We observed a trend towards increased retention among pregnant adolescents during our intervention and a statistically significant increase in uptake of six week HEI testing.
与年长女性相比，感染艾滋病毒的孕妇和哺乳期青少年和年轻女性（AYWLH）在预防母婴传播（PMTCT）服务中的保留率较低。
我们评估了肯尼亚西部 7 家卫生机构针对孕妇和产后 AYWLH 的差异化服务模式，旨在改善抗逆转录病毒治疗（ART）服务的保留率。所有年龄在 25 岁以下的孕妇 AYWLH 在进行产前检查（ANC）时都被邀请参加小组 ANC 访问，包括根据国家指南由卫生机构护士进行自我护理和同伴主导的支持会议。使用 ART 登记数据评估新入组的感染艾滋病毒的孕妇（年龄 <20 岁）和年轻女性（20-24 岁）在 PMTCT 登记后的头 6 个月内的失访（LTFU）发生率。与前期间（2016 年 1 月至 12 月）相比，在实施期间（2017 年 12 月至 2019 年 1 月），比较了新入组开始 ART 的妊娠青少年（<20 岁）和年轻女性（20-24 岁）在 6 周时进行 HIV 暴露婴儿（HEI）检测的采用率的风险比。
在前期间，353 名新入组 ANC 的孕妇 AYWLH 中有 223 名（63.2%）有 ART 数据，而在后期间，450 名中有 320 名（71.1%）有 ART 数据（p=0.02）。在后期间，更多的妇女（62.8%）在首次 ANC 就诊时已知 HIV 阳性，而在前期间为 49.3%（p<0.001）。在年龄 <20 岁的孕妇 AYWLH 中，在前期间 ANC 服务登记后的头 6 个月内，LTFU 的发生率从每 100 人月 2.36 例（95%CI 1.06-5.25）降至后期间的每 100 人月 1.41 例（95%CI 0.53-3.77）。在单变量和多变量分析中，与前期间相比，后期间年龄 <20 岁的 AYWLH 发生 LTFU 的可能性几乎低 40%，尽管这一发现没有达到统计学意义的阈值（调整后的发病率比 0.62，95%CI 0.38-1.01，p=0.057）。在后期间，总体上 HEI 检测率提高了 10%（调整后的风险比 1.10，95%CI 1.01-1.21，p=0.04）。
迫切需要采取干预措施来改善孕妇和产后 AYWLH 的结局。我们观察到在干预期间孕妇青少年的保留率呈上升趋势，6 周时 HEI 检测的采用率有统计学意义的显著提高。
