乌干达一个难以到达的渔业社区开展婴儿早期艾滋病诊断检测。

Early infant diagnosis testing for HIV in a hard-to-reach fishing community in Uganda.

机构信息

Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.

Buvuma District Local Government, Lugazi, Uganda.

出版信息

PLoS One. 2023 Jun 7;18(6):e0268416. doi: 10.1371/journal.pone.0268416. eCollection 2023.

DOI:10.1371/journal.pone.0268416

PMID:37285359

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10246781/

Abstract

BACKGROUND

Infants born to HIV-infected mothers are at a high risk of acquiring the infection. The World Health Organization recommends early diagnosis of HIV-exposed infants (HEIs) through deoxyribonucleic acid polymerase chain reaction (DNA PCR) and rapid HIV testing. Early detection of paediatric HIV is critical for access to antiretroviral therapy (ART) and child survival. However, there is limited evidence of the factors associated with receiving early infant diagnosis (EID) tests of the HIV testing protocol among HEIs in fishing communities in Uganda. This study established the factors associated with receiving EID tests of the HIV testing protocol among HEIs in a hard-to-reach fishing community in Uganda.

METHODS

A cross-sectional study was conducted among HEIs in selected healthcare facilities in Buvuma islands, Buvuma district. We obtained secondary data from mother-infant pair files enrolled in the EID program using a data extraction tool. Data were analysed using STATA Version 14. A modified Poisson regression analysis was used to determine the factors associated with not receiving the 1st DNA PCR test among HEIs enrolled in care.

RESULTS

None of the HEIs had received all the EID tests prescribed by the HIV testing protocol within the recommended time frame for the period of January 2014-December 2016. The proportion of infants that had received the 1st and 2nd DNA PCR, and rapid HIV tests was 39.5%, 6.1%, and 81.0% respectively. Being under the care of a single mother (PR = 1.11, 95% CI: 1.01-1.23, p = 0.023) and cessation of breastfeeding (PR = 0.90, 95% CI: 0.83-0.98, p = 0.025) were significantly associated with not receiving the 1st DNA PCR.

CONCLUSION

Our study revealed that none of the HEIs had received all the EID tests of the HIV diagnosis testing protocol. Receiving the 1st DNA PCR was positively associated with being an infant born to a single mother, and exclusive breastfeeding. Our findings highlight the need for the creation of an enabling environment for mothers and caregivers in order to increase the uptake of early diagnosis services for HEIs. Awareness-raising on the importance of EID should be scaled up in fishing communities. Demographic characteristics such as marital and breastfeeding status should be used as an entry point to increase the proportion of HEIs who receive EID tests.

摘要

背景

感染 HIV 的母亲所生的婴儿感染 HIV 的风险很高。世界卫生组织建议通过脱氧核糖核酸聚合酶链反应（DNA PCR）和快速 HIV 检测对 HIV 暴露婴儿（HEI）进行早期诊断。早期发现儿科 HIV 对于获得抗逆转录病毒治疗（ART）和儿童生存至关重要。然而，在乌干达的渔业社区中，针对 HIV 检测方案中的 HEI 进行早期婴儿诊断（EID）检测的相关因素证据有限。本研究旨在确定在乌干达一个难以到达的渔业社区中，与接受 HIV 检测方案中的 EID 检测相关的因素。

方法

在布武马岛布武马区选定的保健设施中对 HEI 进行了横断面研究。我们使用数据提取工具从母婴对档案中获取了纳入 EID 计划的二级数据。使用 STATA 版本 14 进行数据分析。使用修正后的 Poisson 回归分析来确定在 2014 年 1 月至 2016 年 12 月期间未接受规定的 HIV 检测方案中的 1 次 DNA PCR 检测的 HEI 相关因素。

结果

在 2014 年 1 月至 2016 年 12 月期间，没有任何 HEI 在推荐的时间范围内接受了 HIV 检测方案中规定的所有 EID 检测。接受 1 次和 2 次 DNA PCR 以及快速 HIV 检测的婴儿比例分别为 39.5%、6.1%和 81.0%。仅由母亲照顾（PR = 1.11，95%CI：1.01-1.23，p = 0.023）和停止母乳喂养（PR = 0.90，95%CI：0.83-0.98，p = 0.025）与未接受 1 次 DNA PCR 检测显著相关。

结论

我们的研究表明，没有任何 HEI 接受了 HIV 诊断检测方案中的所有 EID 检测。接受 1 次 DNA PCR 检测与婴儿由单身母亲所生和纯母乳喂养呈正相关。我们的研究结果强调了需要为母亲和照顾者创造一个有利的环境，以提高 HEI 接受早期诊断服务的比例。应在渔业社区中加大对 EID 重要性的宣传力度。人口特征，如婚姻状况和母乳喂养状况，应作为增加接受 EID 检测的 HEI 比例的切入点。