Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Department of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya.
J Acquir Immune Defic Syndr. 2024 Nov 1;97(3):242-252. doi: 10.1097/QAI.0000000000003487. Epub 2024 Oct 7.
Many prevention of vertical transmission (PVT) studies assess outcomes within 12 months postpartum and exclude those lost to follow-up (LTFU), potentially biasing outcomes toward those retained in care.
Five public facilities in western Kenya.
We recruited women living with HIV (WLH) ≥18 years enrolled in antenatal clinic (ANC). WLH retained in care (RW) were recruited during pregnancy and followed with their children through 6 months postpartum; WLH LTFU (LW, last visit >90 days) after ANC enrollment and ≤6 months postpartum were recruited through community tracing. Recontact at 3 years was attempted for all participants. Primary outcomes were retention and child HIV-free survival. Generalized linear regression was used to estimated risk ratios (RRs) for associations with becoming LTFU by 6 months postpartum, adjusting for age, education, facility, travel time to facility, gravidity, income, and new vs. known HIV positive at ANC enrollment.
Three hundred thirty-three WLH (222 RW, 111 LW) were recruited from 2018 to 2019. More LW versus RW were newly diagnosed with HIV at ANC enrollment (49.6% vs. 23.9%) and not virally suppressed at study enrollment (40.9% vs. 7.7%). 6-month HIV-free survival was lower for children of LW (87.9%) versus RW (98.7%). At 3 years, 230 WLH were retained in care (including 51 previously LTFU before 6 months), 30 transferred, 70 LTFU, and 3 deceased. 3-year child HIV-free survival was 81.9% (92.0% for children of RW, 58.6% for LW), 3.7% were living with HIV, 3.7% deceased, and 10.8% had unknown HIV/vital status. Being newly diagnosed with HIV at ANC enrollment was the only factor associated with becoming LTFU (aRR 1.21, 95% CI: 1.11 to 1.31).
Outcomes among those LTFU were worse than those retained in care, underscoring the importance of retention in PVT services. Some, but not all, LW re-engaged in care by 3 years, suggesting the need for PVT services must better address the barriers and transitions women experience during pregnancy and postpartum.
许多预防垂直传播（PVT）的研究在产后 12 个月内评估结果，并排除失访（LTFU）者，这可能使结果偏向于那些接受治疗的人。
肯尼亚西部的五家公立医疗机构。
我们招募了年龄在 18 岁及以上、在产前门诊（ANC）就诊的艾滋病毒感染者（WHV）。在怀孕期间招募留在护理中的 WHV（RW），并在产后 6 个月内对其子女进行随访；ANC 登记后至产后 6 个月期间，通过社区追踪招募 LTFU（LW，最后一次就诊时间超过 90 天）的 WHV。所有参与者均尝试在 3 年后进行重新联系。主要结局是保留和儿童无 HIV 生存。使用广义线性回归来估计产后 6 个月时成为 LTFU 的风险比（RR），并根据年龄、教育程度、机构、到机构的旅行时间、生育次数、收入以及 ANC 登记时的新诊断与已知 HIV 阳性情况进行调整。
2018 年至 2019 年期间，共招募了 333 名 WHV（222 名 RW，111 名 LW）。与 RW 相比，LW 中更多的人在 ANC 登记时新诊断为 HIV（49.6% vs. 23.9%）且研究登记时未病毒抑制（40.9% vs. 7.7%）。LW 儿童的 6 个月无 HIV 生存率（87.9%）低于 RW（98.7%）。3 年后，有 230 名 WHV 继续接受治疗（包括 6 个月前之前 LTFU 的 51 名），30 名转院，70 名失访，3 名死亡。3 年儿童无 HIV 生存率为 81.9%（RW 儿童为 92.0%，LW 儿童为 58.6%），3.7%的儿童感染了 HIV，3.7%的儿童死亡，10.8%的儿童 HIV/生命状况未知。ANC 登记时新诊断为 HIV 是成为 LTFU 的唯一相关因素（ARR 1.21，95%CI：1.11-1.31）。
与继续接受治疗的人相比，失访者的结局更差，这突显了在 PVT 服务中保留患者的重要性。LW 中的一些人（但不是全部）在 3 年内重新接受了治疗，这表明 PVT 服务必须更好地解决妇女在怀孕期间和产后面临的障碍和过渡问题。
