GRAPH Network, University of Geneva, Geneva, Switzerland
Epidemiology and Biostatistics, Kamuzu University of Health Sciences, Lilongwe, Central Region, Malawi.
BMJ Paediatr Open. 2022 Jan;6(1). doi: 10.1136/bmjpo-2021-001275.
Despite the availability of individual-level data of infants accessing HIV DNA-PCR testing service, there has been little in-depth analysis of such data. Therefore, we describe trends in risk of HIV infection among Malawi's HIV-exposed infants (HEI) with DNA-PCR HIV test result from 2013 to 2020.
This is an implementation study using routinely collected patient-level HIV DNA-PCR test result data extracted from the national Laboratory Management Information System database managed by the Department of HIV/AIDS between 1 January 2013 and 30 June 2020. We calculated frequencies, proportions and odds ratio (OR) with their associated 95% CI. We performed a random-effects logistic regression to determine the risk factors associated with HIV infection in infants, controlling for the spatial autocorrelation between districts and adjusting for other variables.
We evaluated 255 229 HEI across 750 facilities in 28 districts. The HIV DNA-PCR test was performed within 2 months in 57% of the children. The overall HIV prevalence among all tested HEI between 2013 and 2020 was 7.2% (95% CI 7.1% to 7.3%). We observed a decreasing trend in the proportion of HEI that tested HIV positive from 7.0% (95% CI 6.6% to 7.4%) in 2013 to 5.7% (95% CI 5.4% to 5.9%) in 2015 followed by an increase to 9.9% (95% CI 9.6% to 10.2%) in 2017 and thereafter a decreasing trend between 2017 (i.e. 9.72% (95%CI: 9.43-10.01)) and 2020 (i.e. 3.86% (95%CI: 3.34-4.37)). The HIV prevalence increased by age of the HEI. There was spatial heterogeneity of HIV prevalence between districts of Malawi. The prevalence of HIV was higher among the HEI from the Northern region of Malawi.
The main findings of the study are that the DNA test is performed within 2 months only in 57% of the children, that the decreasing trend of HIV prevalence among HEI observed up to 2015 was followed by an increase up to 2017 and a decrease afterwards, and that the risk of HIV infection increased with age at HIV testing. We summarised spatial and temporal trends of risk of HIV infection among HEI in Malawi between 2013 and 2020. There is need to ensure that all the HEI are enrolled in HIV care by 8 weeks of age in order to further reduce the risk of HIV in this population.
尽管有婴儿接受 HIV DNA-PCR 检测服务的个体水平数据，但对这些数据的深入分析却很少。因此，我们描述了 2013 年至 2020 年期间马拉维 HIV 暴露婴儿（HEI）的 HIV 感染风险趋势，这些数据来自国家实验室管理信息系统数据库中定期收集的患者水平 HIV DNA-PCR 检测结果。
这是一项实施研究，使用从 2013 年 1 月 1 日至 2020 年 6 月 30 日期间由艾滋病司管理的国家实验室管理信息系统数据库中提取的常规收集的患者水平 HIV DNA-PCR 检测结果数据。我们计算了频率、比例和比值比（OR）及其相关的 95%置信区间（CI）。我们进行了随机效应逻辑回归分析，以确定与婴儿 HIV 感染相关的风险因素，同时控制了地区之间的空间自相关，并调整了其他变量。
我们评估了来自 28 个地区的 750 个设施的 255229 名 HEI。2013 年至 2020 年期间，57%的儿童在 2 个月内进行了 HIV DNA-PCR 检测。所有接受检测的 HEI 的总体 HIV 患病率为 7.2%（95%CI 7.1%至 7.3%）。我们观察到，HEI 中 HIV 阳性检测比例呈下降趋势，从 2013 年的 7.0%（95%CI 6.6%至 7.4%）下降到 2015 年的 5.7%（95%CI 5.4%至 5.9%），随后在 2017 年上升至 9.9%（95%CI 9.6%至 10.2%），此后，2017 年（即 9.72%（95%CI：9.43-10.01））与 2020 年（即 3.86%（95%CI：3.34-4.37））之间的 HIV 检测率呈下降趋势。HEI 的 HIV 感染率随年龄增长而增加。马拉维各地区的 HIV 感染率存在空间异质性。HIV 感染率在马拉维北部地区的 HEI 中更高。
本研究的主要发现是，只有 57%的儿童在 2 个月内进行 DNA 检测，2015 年之前观察到的 HIV 阳性 HEI 患病率下降趋势之后，HIV 患病率在 2017 年上升，随后又下降，而且 HIV 感染风险随 HIV 检测时的年龄增长而增加。我们总结了 2013 年至 2020 年期间马拉维 HIV 暴露婴儿的 HIV 感染风险的时空趋势。有必要确保所有 HEI 在 8 周龄时都纳入 HIV 护理，以进一步降低该人群的 HIV 风险。
