Predictors of Successful Early Infant Diagnosis of HIV in a Rural District Hospital in Zambezia, Mozambique
Predictors of Successful Early Infant Diagnosis of HIV in a Rural District Hospital in Zambezia, Mozambique
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DOI：
10.1097/qai.0b013e318207a535
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发表时间：
2011-04-01
影响因子：
3.6
通讯作者：
Moon, Troy D.
中科院分区：
文献类型：
--
作者：
Cook, Rebecca E.;Ciampa, Philip J.;Moon, Troy D.
背景：阻碍儿科抗逆转录病毒治疗及时启动的一个关键挑战是，从母亲在怀孕期间诊断出艾滋病毒到分娩后返回进行婴儿早期艾滋病毒诊断期间，母亲及其婴儿无法进行随访。我们试图找出莫桑比克赞比西亚省农村地区 HIV 暴露婴儿随访的障碍。方法：我们在 443 名 HIV 感染母亲及其婴儿的回顾性队列中确定了早期婴儿诊断的随访率和首次检测的年龄。使用多变量逻辑回归模型来确定与成功随访相关的因素。结果：在 443 对母婴中，217 名（49%）母亲参加了成人 HIV 护理诊所，只有 110 名（25%）婴儿被带去进行早期婴儿诊断。早期婴儿诊断随访的预测因素包括家庭规模较大（比值比 [OR]，1.29；95% 置信区间 [CI]，1.09-1.53）、独立的母亲收入来源（OR，10.8；95% CI，3.42-34.0）、距医院较远（OR，2.14；95% CI，1.01-4.51）和母亲接受抗逆转录病毒治疗（OR，3.15；95% CI，1.02-9.73）。 105 名婴儿首次测试的中位年龄为 5 个月（四分位数范围，2-7）； 16%的受检婴儿被感染。结论：莫桑比克农村地区四分之三的艾滋病毒感染妇女没有带孩子进行婴儿艾滋病毒早期诊断。母亲接受抗逆转录病毒治疗对母亲健康具有有利影响，将增加婴儿早期诊断的可能性。我们正在与当地卫生当局合作，改善艾滋病毒感染妇女与艾滋病毒护理的联系，以最大限度地提高婴儿早期诊断和护理效果。
Background: A key challenge inhibiting the timely initiation of pediatric antiretroviral treatment is the loss to follow-up of mothers and their infants between the time of mothers' HIV diagnoses in pregnancy and return after delivery for early infant diagnosis of HIV. We sought to identify barriers to follow-up of HIV-exposed infants in rural Zambezia Province, Mozambique.Methods: We determined follow-up rates for early infant diagnosis and age at first test in a retrospective cohort of 443 HIV-infected mothers and their infants. Multivariable logistic regression models were used to identify factors associated with successful follow-up.Results: Of the 443 mother-infant pairs, 217 (49%) mothers enrolled in the adult HIV care clinic, and only 110 (25%) infants were brought for early infant diagnosis. The predictors of follow-up for early infant diagnosis were larger household size (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09-1.53), independent maternal source of income (OR, 10.8; 95% CI, 3.42-34.0), greater distance from the hospital (OR, 2.14; 95% CI, 1.01-4.51), and maternal receipt of antiretroviral therapy (OR, 3.15; 95% CI, 1.02-9.73). The median age at first test among 105 infants was 5 months (interquartile range, 2-7); 16% of the tested infants were infected.Conclusions: Three of four HIV-infected women in rural Mozambique did not bring their children for early infant HIV diagnosis. Maternal receipt of antiretroviral therapy has favorable implications for maternal health that will increase the likelihood of early infant diagnosis. We are working with local health authorities to improve the linkage of HIV-infected women to HIV care to maximize early infant diagnosis and care.