Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi.
Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
PLoS One. 2022 Sep 1;17(9):e0273639. doi: 10.1371/journal.pone.0273639. eCollection 2022.
Malawi spearheaded the development and implementation of Option B+ for prevention of mother-to-child transmission of HIV (PMTCT), providing life-long ART for all HIV-positive pregnant and breastfeeding women. We used data from the 2015-2016 Malawi Population-based HIV Impact Assessment (MPHIA) to estimate progress toward 90-90-90 targets (90% of those with HIV know their HIV-positive status; of these, 90% are receiving ART; and of these, 90% have viral load suppression [VLS]) for HIV-positive women reporting a live birth in the previous 3 years.
MPHIA was a nationally representative household survey; consenting eligible women aged 15-64 years were interviewed on pregnancies and outcomes, including HIV status during their most recent pregnancy, PMTCT uptake, and early infant diagnosis (EID) testing. Descriptive analyses were weighted to account for the complex survey design. Viral load (VL) results were categorized by VLS (<1,000 copies/mL) and undetectable VL (target not detected/below the limit of detection).
Of the 3,153 women included in our analysis, 371 (10.1%, 95% confidence interval [CI]: 8.8%-11.3%) tested HIV positive in the survey. Most HIV-positive women (84.2%, 95% CI: 79.9%-88.6%) reported knowing their HIV-positive status; of these, 94.9% (95% CI: 91.7%-98.2%) were receiving ART; and of these, 91.2% (95% CI: 87.4%-95.0%) had VLS. Among the 371 HIV-positive women, 76.0% (95% CI: 70.4%-81.7%) had VLS and 66.5% (95% CI: 59.8%-73.2%) had undetectable VL. Among 262 HIV-exposed children, 50.8% (95% CI: 42.8%-58.8%) received EID testing within 2 months of birth, whereas 17.9% (95% CI: 11.9%-23.8%) did not receive EID testing. Of 190 HIV-exposed children with a reported HIV test result, 2.1% (95% CI: 0.0%-4.6%) had positive results.
MPHIA data demonstrate high PMTCT uptake at a population level. However, our results identify some gaps in VLS in postpartum women and EID testing.
马拉维率先制定并实施了 B+ 方案，以预防艾滋病毒母婴传播（PMTCT），为所有艾滋病毒阳性的孕妇和哺乳期妇女提供终生抗逆转录病毒治疗（ART）。我们使用了来自 2015-2016 年马拉维基于人群的艾滋病毒影响评估（MPHIA）的数据，来估计在过去 3 年内报告有活产的艾滋病毒阳性妇女中，朝着 90-90-90 目标（90%的艾滋病毒感染者知晓其艾滋病毒阳性状况；其中 90%接受了 ART；其中 90%的病毒载量得到抑制[VLS]）取得的进展。
MPHIA 是一项全国代表性的家庭调查；同意参加的年龄在 15-64 岁之间的合格妇女接受了关于怀孕和结局的访谈，包括最近一次怀孕期间的艾滋病毒状况、PMTCT 的采用情况以及早期婴儿诊断（EID）检测。描述性分析根据复杂的调查设计进行加权。病毒载量（VL）结果根据病毒载量抑制（<1000 拷贝/毫升）和不可检测的 VL（目标未检测/低于检测限）进行分类。
在我们的分析中，纳入了 3153 名妇女，其中 371 名（10.1%，95%置信区间[CI]：8.8%-11.3%）在调查中艾滋病毒检测呈阳性。大多数艾滋病毒阳性妇女（84.2%，95%CI：79.9%-88.6%）报告知晓其艾滋病毒阳性状况；其中 94.9%（95%CI：91.7%-98.2%）正在接受 ART；其中 91.2%（95%CI：87.4%-95.0%）的病毒载量得到抑制。在 371 名艾滋病毒阳性妇女中，76.0%（95%CI：70.4%-81.7%）的病毒载量得到抑制，66.5%（95%CI：59.8%-73.2%）的病毒载量不可检测。在 262 名艾滋病毒暴露的儿童中，50.8%（95%CI：42.8%-58.8%）在出生后 2 个月内接受了 EID 检测，而 17.9%（95%CI：11.9%-23.8%）未接受 EID 检测。在报告有艾滋病毒检测结果的 190 名艾滋病毒暴露儿童中，2.1%（95%CI：0.0%-4.6%）的检测结果呈阳性。
MPHIA 数据表明，人群层面的 PMTCT 采用率很高。然而，我们的结果表明，在产后妇女的病毒载量抑制和 EID 检测方面存在一些差距。
