UK national clinical audit: management of pregnancies in women with HIV
UK national clinical audit: management of pregnancies in women with HIV
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DOI：
10.1186/s12879-017-2255-6
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发表时间：
2017-02-20
影响因子：
3.7
通讯作者：
Gilleece, Y.
中科院分区：
文献类型：
--
作者：
Raffe, S.;Curtis, H.;Gilleece, Y.
背景：1982 年，人们首次认识到孕妇和未出生的孩子之间存在艾滋病毒传播的可能性。此后，制定了一系列复杂的降低风险的措施。该项目旨在审查英国对妊娠期艾滋病毒的管理，作为英国艾滋病毒协会 (BHIVA) 审计计划的一部分。方法：国家妊娠期和儿童艾滋病毒研究 (NSHPC) 是一项基于人群的监测研究，提供了预产期为 2013 年 1 月 1 日至 2014 年 6 月 30 日的妊娠数据。服务部门还完成了对当地管理政策的调查。根据 2012 年 BHIVA 怀孕指南对数据进行了审核。结果：在审核期间，报告了 1483 例怀孕情况，112 个服务机构完成了调查。 99% 的人报告使用了专门的多学科团队，但 26% 的人既不包括专业助产士也不包括护士。 17% 的服务机构报告称，对产前诊断的妇女进行艾滋病毒专家审查的时间延迟超过 1 周。 9% 的服务机构在紧急艾滋病毒检测方面遇到了问题，但另外 49% 的服务机构并未出现紧急检测的需要。延迟超过 2 小时才能获得紧急结果的情况很常见。 37% 的女性在怀孕期间开始抗逆转录病毒治疗 (ART)，其中 > 94% 的治疗方案均按照指南进行。晚期 ART 开始很常见，特别是对于 CD4 计数低或病毒载量高的患者。 11% 的服务机构报告当地政策违反了有关 VL < 50 拷贝/mL 且≥ 36 周的女性分娩方式的指南。根据 NSHPC 报告，27% 的女性在病毒学上符合阴道分娩的条件，计划通过 CS 进行分娩。 结论：英国的孕妇基本上是按照 BHIVA 指南进行管理的。需要进行改进，以确保及时转诊和启动 ART，以确保获得最佳结果。
Background: The potential for HIV transmission between a pregnant woman and her unborn child was first recognized in 1982. Since then a complex package of measures to reduce risk has been developed. This project aims to review UK management of HIV in pregnancy as part of the British HIV Association (BHIVA) audit programme.Methods: The National Study of HIV in Pregnancy and Childhood (NSHPC), a population-based surveillance study, provided data for pregnancies with an expected delivery date from 1/1/13 - 30/6/14. Services also completed a survey on local management policies. Data were audited against the 2012 BHIVA pregnancy guidelines.Results: During the audit period 1483 pregnancies were reported and 112 services completed the survey. Use of dedicated multidisciplinary teams was reported by 99% although 26% included neither a specialist midwife nor nurse. 17% of services reported delays > 1 week for HIV specialist review of women diagnosed antenatally. Problematic urgent HIV testing had been experienced by 9% of services although in a further 49% the need for urgent testing had not arisen. Delays of > 2 h in obtaining urgent results were common. Antiretroviral therapy (ART) was started during pregnancy in 37% women with > 94% regimens in accordance with guidelines. Late ART initiation was common, particularly in those with a low CD4 count or high viral load. Eleven percent of services reported local policy contrary to guidelines regarding delivery mode for women with a VL < 50 copies/mL at >= 36 weeks. According to NSHPC reports 27% of women virologically eligible for vaginal delivery planned to deliver by CS.Conclusions: Pregnant women in the UK are managed largely in accordance with BHIVA guidelines. Improvements are needed to ensure timely referral and ART initiation to ensure the best possible outcomes.