Field effectiveness of combination antiretroviral prophylaxis for the prevention of mother-to-child HIV transmission in rural Zambia.
Field effectiveness of combination antiretroviral prophylaxis for the prevention of mother-to-child HIV transmission in rural Zambia.
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联合抗逆转录病毒预防的现场有效性，可预防赞比亚农村农村的母子艾滋病毒传播。
DOI：
10.1097/qad.0b013e32835e3937
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发表时间：
2013-05-15
期刊：
影响因子：
--
通讯作者：
Chi BH
中科院分区：
文献类型：
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作者：
Gartland MG;Chintu NT;Li MS;Lembalemba MK;Mulenga SN;Bweupe M;Musonda P;Stringer EM;Stringer JS;Chi BH
在赞比亚农村的9个初级保健诊所中，有284名妊娠≥28周的艾滋病毒感染孕妇在2009年4月至2011年1月期间开始提供预防母婴传播（PMTCT）服务。在4个“干预”地点，预防母婴传播包括普遍联合抗逆转录病毒预防(即：无论CD4计数如何)，从怀孕到停止母乳喂养。在五个“对照”地点，妇女在产前接受齐多夫定和围产期服用奈韦拉平，这是当时的标准护理。对照组没有母乳喂养期间的预防措施。产后12个月，干预点母亲所生的104名婴儿中有1名（1.0%）感染艾滋病毒，而对照组接受护理的116名婴儿中有14名（12.1%）感染艾滋病毒（相对危险度[RR]: 12.6, 95%CI: 2.2-73.1； P=0.005）。当我们考虑艾滋病毒感染或死亡的综合结果时，在整个研究人群中（RR: 3.4, 95%CI: 1.6-7.6； P=0.002）和在CD4 bb0 350细胞/μL的妇女的亚分析中（RR: 3.2; 95%CI: 1.1-9.6； P=0.04）观察到类似的趋势。与基于产前齐多夫定和围产期奈韦拉平的预防母婴传播服务相比，提供孕产妇联合预防给暴露于艾滋病毒的婴儿带来了可衡量的健康益处。需要进行实施研究，以进一步定制和优化这些战略，以适应类似的现场环境。
To evaluate the effectiveness of maternal combination antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV (PMTCT) in a program setting Prospective cohort study Nine primary care clinics in rural Zambia 284 HIV-infected pregnant women at ≥28 weeks gestation initiating PMTCT services between April 2009 and January 2011 and their newborn infants In four “intervention” sites, PMTCT comprised universal combination antiretroviral prophylaxis (i.e., irrespective of CD4 count) from pregnancy until the cessation of breastfeeding. In five “control” sites, women received antenatal zidovudine and peripartum nevirapine, the standard of care at the time. Prophylaxis during breastfeeding was not available in control sites. Cumulative infant HIV infection and death at 12 months postpartum At 12 month postpartum, 1 of 104 (1.0%) infants born to mothers at the intervention sites were HIV-infected, compared to 14 of 116 (12.1%) receiving care in the control sites (relative risk [RR]: 12.6, 95%CI: 2.2-73.1; P=0.005). When we considered the composite outcome of HIV infection or death, similar trends were observed in the overall study population (RR: 3.4, 95%CI: 1.6-7.6; P=0.002) and in a sub-analysis of women with CD4 >350 cells/μL (RR: 3.2; 95%CI: 1.1-9.6; P=0.04). When compared to PMTCT services based on antenatal zidovudine and peripartum nevirapine, the provision of maternal combination prophylaxis imparted measurable health benefits to HIV-exposed infants. Implementation research is needed to further tailor and optimize these strategies for similar field settings.