What will it take for the Global Plan priority countries in Sub-Saharan Africa to eliminate mother-to-child transmission of HIV?
What will it take for the Global Plan priority countries in Sub-Saharan Africa to eliminate mother-to-child transmission of HIV?
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DOI：
10.1186/s12879-019-4393-5
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发表时间：
2019-09-16
影响因子：
3.7
通讯作者：
Mahy, Mary
中科院分区：
文献类型：
--
作者：
Goga, Ameena E.;Thu-Ha Dinh;Mahy, Mary
背景2016《开始免费、保持免费、无艾滋病》全球议程建立在2011-2015年全球计划的基础上。它将世界上90%艾滋病毒阳性孕妇居住的22个国家列为优先事项，旨在消除艾滋病毒的垂直传播(EMTCT)并让母亲活下来。截至2019年，没有一个全球计划优先国家实现了紧急母婴传播；但有11个非优先国家实现了这一目标。本文综合了最初四个被批准进行紧急技术转移的国家以及位于撒哈拉以南非洲的21个全球计划优先国家(SSA)的特点。我们考虑了21个SSA全球计划优先国家艾滋病毒垂直传播(母婴传播)的驱动因素。方法使用PubMed、Science Direct和Google搜索引擎进行文献综述，获取全球和国家层面的信息，了解全球和国家层面上前4个经母婴传播技术验证的国家和21个SSA全球计划优先国家的艾滋病毒相关背景和卫生系统特征。仅代表一家诊所、医院或地区的数据被排除在外。此外，还联系了从事紧急母婴传播的主要全球专家，以获得对已公布数据的澄清。我们应用了三种理论(世界卫生组织加强卫生系统的基石、van Olmen的卫生系统动力学框架和Baral的艾滋病毒风险的社会生态模型)来理解和解释经EMTCT验证和未验证的国家之间的差异。此外，结构方程模型(SEM)和线性回归被用来解释婴儿艾滋病毒暴露、获得抗逆转录病毒治疗的机会与两个结果之间的关系：(1)母婴传播百分比；(3)每10万名活产中儿童新感染艾滋病毒的人数(儿童艾滋病毒病例率)。结果与全球计划优先国家相比，经紧急母婴传播计划验证的国家艾滋病毒感染率较低，母乳喂养较少，领导力、卫生部门或国家内的治理、基础设施和服务提供方面的挑战较少。尽管截至2016年，经紧急母婴传播方案验证的国家和全球计划优先国家已采用公共卫生办法预防艾滋病毒，建议对所有艾滋病毒阳性孕妇和哺乳期妇女进行终身抗逆转录病毒治疗，但经紧急情况监测方案验证的国家还包括接触者追踪，如协助伴侣通知，并将妇幼保健、性健康和生殖健康服务与艾滋病毒感染、性传播感染和病毒性肝炎服务相结合。此外，“全球计划”优先考虑的国家在关键的生殖健康指标方面的数据有限，例如计划生育需求未得到满足，产前护理、艾滋病毒检测和三重抗逆转录病毒疗法的覆盖面各不相同，接触者追踪也非常有限。结构方程模型(SEM)和线性回归分析表明，ART访问对MTCT百分比具有保护作用(p
Background The 2016 'Start Free, Stay Free, AIDS Free' global agenda, builds on the 2011-2015 'Global Plan'. It prioritises 22 countries where 90% of the world's HIV-positive pregnant women live and aims to eliminate vertical transmission of HIV (EMTCT) and to keep mothers alive. By 2019, no Global Plan priority country had achieved EMTCT; however, 11 non-priority countries had. This paper synthesises the characteristics of the first four countries validated for EMTCT, and of the 21 Global Plan priority countries located in Sub-Saharan Africa (SSA). We consider what drives vertical transmission of HIV (MTCT) in the 21 SSA Global Plan priority countries. Methods A literature review, using PubMed, Science direct and the google search engine was conducted to obtain global and national-level information on current HIV-related context and health system characteristics of the first four EMTCT-validated countries and the 21 SSA Global Plan priority countries. Data representing only one clinic, hospital or region were excluded. Additionally, key global experts working on EMTCT were contacted to obtain clarification on published data. We applied three theories (the World Health Organisation's building blocks to strengthen health systems, van Olmen's Health System Dynamics framework and Baral's socio-ecological model for HIV risk) to understand and explain the differences between EMTCT-validated and non-validated countries. Additionally, structural equation modelling (SEM) and linear regression were used to explain associations between infant HIV exposure, access to antiretroviral therapy and two outcomes: (i) percent MTCT and (iii) number of new paediatric HIV infections per 100 000 live births (paediatric HIV case rate). Results EMTCT-validated countries have lower HIV prevalence, less breastfeeding, fewer challenges around leadership, governance within the health sector or country, infrastructure and service delivery compared with Global Plan priority countries. Although by 2016 EMTCT-validated countries and Global Plan priority countries had adopted a public health approach to HIV prevention, recommending lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and lactating women, EMCT-validated countries had also included contact tracing such as assisted partner notification, and had integrated maternal and child health (MCH) and sexual and reproductive health (SRH) services, with services for HIV infection, sexually transmitted infections, and viral hepatitis. Additionally, Global Plan priority countries have limited data on key SRH indicators such as unmet need for family planning, with variable coverage of antenatal care, HIV testing and triple antiretroviral therapy (ART) and very limited contact tracing. Structural equation modelling (SEM) and linear regression analysis demonstrated that ART access protects against percent MTCT (p