Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.
School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
PLoS One. 2023 Oct 4;18(10):e0292427. doi: 10.1371/journal.pone.0292427. eCollection 2023.
Despite being a preventable disease, pediatric HIV infection continues to be a public health concern due to the morbidity and mortality associated with the disease. Vertical transmission of HIV occurs when a mother living with HIV passes the virus to her baby during pregnancy, childbirth, or breastfeeding. Globally, the vertical transmission rate of HIV is 9% with sub-Saharan Africa accounting for 90% of these infections. In Kenya, the national vertical transmission rates of HIV stood at 11.5% by the end of 2018, with a target to reduce vertical transmission rates to below 5% and 2% in breastfeeding and non-breastfeeding infants respectively, by the end of 2021.
To determine the prognostic factors influencing HIV-free survival among infants enrolled for HIV early infant diagnosis (EID) services in selected hospitals in Nairobi County, Kenya.
A prospective cohort study design was adopted. HIV exposed infants were recruited at six weeks to determine HIV-free survival over 12 months follow up. Simple random sampling was used to select 166 infants and data were collected from the mothers using semi-structured interviewer-administered questionnaires. Log-rank tests were used to test for associations at the bi-variable level while Cox-proportional regression was used to analyze data at the multi-variable level, with the aid of STATA 14 software. Ethical approval was obtained from Kenya Medical Research Institute, Scientific Ethics Review Unit.
The overall infant HIV incidence rate over one-year follow-up was 9 cases per 100 person-years (95% CI: 5.465-16.290). The failure event was defined as an infant with a positive PCR test during the study period with total failures being 13 (9.41%) over 12 months. Prognostic factors associated with poor infant HIV-free survival were young maternal age (18-24 years) and mothers with a recent HIV diagnosis of ≤ 2 years since a positive HIV diagnosis (HR 5.97 CI: 1.20, 29.58) and (HR 6.97 CI: 1.96, 24.76), respectively.
Maternal prognostic factors associated with poor infant HIV-free survival were young maternal age (18-24 years) and recent maternal HIV diagnosis of ≤ 2 years since positive HIV diagnosis. The study recommended the development of an intervention package with more rigorous adherence counseling and close monitoring for young mothers, and mothers with recent HIV diagnoses.
尽管小儿 HIV 感染是一种可预防的疾病，但由于与该疾病相关的发病率和死亡率，它仍然是一个公共卫生关注的问题。HIV 经母婴垂直传播是指携带 HIV 的母亲在妊娠、分娩或哺乳期间将病毒传染给婴儿。在全球范围内，HIV 的垂直传播率为 9%，其中撒哈拉以南非洲地区占这些感染的 90%。在肯尼亚，截至 2018 年底，全国 HIV 母婴垂直传播率为 11.5%，目标是到 2021 年底，将母乳喂养和非母乳喂养婴儿的母婴垂直传播率分别降低到 5%和 2%以下。
确定影响肯尼亚内罗毕县选定医院接受 HIV 早期婴儿诊断 (EID) 服务的婴儿 HIV 无存活的预后因素。
采用前瞻性队列研究设计。在 6 周时招募 HIV 暴露婴儿，以确定 12 个月随访期间的 HIV 无存活情况。采用简单随机抽样选择 166 名婴儿，并使用半结构式访谈员管理问卷从母亲处收集数据。对数秩检验用于双变量水平的相关性检验，而 Cox 比例风险回归用于多变量水平的数据分析，使用 STATA 14 软件。肯尼亚医学研究所科学伦理审查小组获得了伦理批准。
在为期一年的随访中，总的婴儿 HIV 发病率为每 100 人年 9 例（95%CI：5.465-16.290）。失败事件定义为在研究期间进行 PCR 检测呈阳性的婴儿，在 12 个月内总失败率为 13 例（9.41%）。与婴儿 HIV 无存活不良相关的预后因素是母亲年龄较年轻（18-24 岁）和母亲最近的 HIV 诊断距离阳性 HIV 诊断时间≤2 年（HR 5.97 CI：1.20，29.58）和（HR 6.97 CI：1.96，24.76）。
与婴儿 HIV 无存活不良相关的母亲预后因素是母亲年龄较年轻（18-24 岁）和母亲最近的 HIV 诊断距离阳性 HIV 诊断时间≤2 年。该研究建议制定一套干预措施，为年轻母亲和最近 HIV 诊断的母亲提供更严格的坚持治疗咨询和密切监测。
