南非在新冠疫情前和疫情期间的预防母婴传播（PMTCT）项目结果。

Prevention-of-mother-to-child-transmission (PMTCT) program outcomes in South Africa in the pre-COVID and COVID eras.

机构信息

Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa.

Kwadabeka Community Health Centre, KwaDabeka, South Africa.

出版信息

BMC Public Health. 2023 Jul 20;23(1):1395. doi: 10.1186/s12889-023-16214-5.

DOI:10.1186/s12889-023-16214-5

PMID:37474920

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10357590/

Abstract

INTRODUCTION

Two decades after implementing the Prevention of Mother to Child transmission (PMTCT) program, South Africa has still not managed to eliminate intrauterine mother-to-child (MTCT) HIV transmission. During the COVID pandemic access to maternal health services was reduced, potentially compromising the PMTCT program.

METHOD

A retrospective record review was conducted at a midwife-run obstetric unit in a high HIV prevalence setting. Data on pregnant women who delivered between January 2019 and December 2020 were analysed to evaluate predictors for MTCT, and compare pre-COVID and COVID-era changes in maternal and infant HIV incidence and prevalence.

RESULTS

A total of 1660 women delivered at the facility over a 24-month period (Jan 2019-Dec 2020), of whom 92.8% enrolled for antenatal care in 2019 and 94.6% in 2020. A significantly greater proportion of women were aware of their HIV status before enrolling for antenatal care in the pre-COVID (2019) than COVID (2020) period (88% vs 40.2%; p < 0.05). There was a significant increase in new HIV infection after enrolling for antenatal care during the COVID period compared to pre-COVID period (120 vs 62 women, p < 0.05). There was also a significant increase in the HIV prevalence among women who delivered during the COVID period than in the pre-COVID era (43.5% compared to 35.8%, p < 0.05). However, more than 95% of HIV-positive women initiated ART in both periods. Overall, a total of thirteen infants tested HIV positive (2.1% MTCT rate), with no difference in MTCT between 2019 and 2020. Infants born to women on antiretroviral therapy (ART) were 93% less likely to have a positive PCR test than those whose mothers who were not on ART. (OR = 0.07, 95% CI 0.031:0.178, p < 0.05).

CONCLUSION

The increase in maternal HIV incidence and prevalence during the COVID era suggest a lapse in HIV prevention strategies during the COVID pandemic. There is an urgent need to improve community test-and-treat campaigns among women of reproductive age in the community and increase access to HIV pre-exposure prophylaxis for pregnant women, especially during periods of health crises.

摘要

引言

在实施预防母婴传播（PMTCT）项目二十年后，南非仍未能消除宫内母婴（MTCT）艾滋病毒传播。在 COVID 大流行期间，获得孕产妇保健服务的机会减少，可能会影响 PMTCT 项目。

方法

在高艾滋病毒流行地区的助产士管理产科单位进行回顾性病历审查。分析了 2019 年 1 月至 2020 年 12 月期间分娩的孕妇的数据，以评估 MTCT 的预测因素，并比较 COVID 前和 COVID 期间母婴 HIV 发病率和患病率的变化。

结果

在 24 个月期间（2019 年 1 月至 2020 年 12 月），共有 1660 名妇女在该设施分娩，其中 92.8%的妇女在 2019 年和 94.6%的妇女在 2020 年参加了产前护理。在 COVID 前（2019 年）参加产前护理的妇女中，有更高比例的妇女在参加产前护理之前就知道自己的艾滋病毒状况（88%比 40.2%；p<0.05）。与 COVID 前（2019 年）相比，在 COVID 期间参加产前护理后新感染艾滋病毒的妇女显著增加（120 名妇女比 62 名妇女，p<0.05）。在 COVID 期间分娩的妇女中，艾滋病毒流行率也显著高于 COVID 前（43.5%比 35.8%，p<0.05）。然而，在这两个时期，超过 95%的艾滋病毒阳性妇女开始接受抗逆转录病毒治疗。总体而言，共有 13 名婴儿 HIV 检测呈阳性（MTCT 率为 2.1%），2019 年和 2020 年 MTCT 率没有差异。与未接受抗逆转录病毒治疗的母亲所生婴儿相比，接受抗逆转录病毒治疗的母亲所生婴儿 PCR 检测呈阳性的可能性低 93%。（OR=0.07，95%CI 0.031:0.178，p<0.05）。