Progress in prevention of mother-to-child transmission of HIV infection in Ukraine: results from a birth cohort study.
Progress in prevention of mother-to-child transmission of HIV infection in Ukraine: results from a birth cohort study.
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DOI：
10.1186/1471-2334-9-40
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发表时间：
2009-04-07
影响因子：
3.7
通讯作者：
Ukraine European Collaborative Study Group
中科院分区：
文献类型：
--
作者：
Thorne C;Semenenko I;Pilipenko T;Malyuta R;Ukraine European Collaborative Study Group
乌克兰是东欧艾滋病毒流行的中心，也是当今世界范围内艾滋病毒流行速度最快的地区；全国艾滋病毒感染率目前估计为 1.6%。我们的目标是在乌克兰正在进行的出生队列研究的背景下，评估八年来在乌克兰运营环境中预防母婴传播 (PMTCT) 干预措施的采用情况和有效性。欧洲合作研究 (ECS) 是一项正在进行的出生队列研究，其中招募了在怀孕前、怀孕期间或分娩时发现的艾滋病毒感染孕妇，并对她们的婴儿进行前瞻性随访。乌克兰的三个中心于 2000 年开始招募，另外三个中心于 2006 年 9 月加入。在注册的 3,356 名女性中，21% (689) 报告了当前或过去注射吸毒 (IDU) 的情况。大多数妇女在产前得到诊断，其中，在妊娠早期/中期诊断的比例从 2000/01 年的 47% (83/178) 增加到 2006/07 年的 73% (776/1060) (p < 0.001)；产时诊断与 IDU 相关（调整后的比值比 4.38；95%CI 3.19–6.02）。未接受任何抗逆转录病毒预防的女性比例从 2001 年的 18% (36/205) 下降到 2007 年的 7% (61/843) (p < 0.001)。 2003 年之后，单独使用 sdNVP 的情况大幅下降，同时齐多夫定预防性用药有所增加。 2000 年至 2007 年间，产前齐多夫定预防用药的中位持续时间从 24 天增加到 72 天。随着时间的推移，选择性剖腹产 (CS) 率相对稳定，总体为 34%。母婴传播（MTCT）率从 2001 年的 15.2%（95%CI 10.2-21.4）下降到 2006 年的 7.0%（95%CI 2.6-14.6）。在调整分析中，与阴道分娩相比，选择性 CS 的 MTCT 风险降低了 43%，与不预防相比，齐多夫定的 MTCT 风险降低了 75%。乌克兰在预防母婴传播干预措施的使用方面取得了实质性进展，包括对感染艾滋病毒的孕妇进行早期诊断，并提高抗逆转录病毒预防的覆盖率，并且初始母婴传播率已减少一半以上。未来的研究应重点关注注射吸毒者等难以接触到的人群，以及错失的进一步降低母婴传播率的机会。
Ukraine was the epicentre of the HIV epidemic in Eastern Europe, which has the most rapidly accelerating HIV epidemic world-wide today; national HIV prevalence is currently estimated at 1.6%. Our objective was to evaluate the uptake and effectiveness of interventions for prevention of mother-to-child transmission (PMTCT) over an eight year period within operational settings in Ukraine, within the context of an ongoing birth cohort study. The European Collaborative Study (ECS) is an ongoing birth cohort study in which HIV-infected pregnant women identified before or during pregnancy or at delivery were enrolled and their infants prospectively followed. Three centres in Ukraine started enrolling in 2000, with a further three joining in September 2006. Of the 3356 women enrolled, 21% (689) reported current or past injecting drug use (IDU). Most women were diagnosed antenatally and of those, the proportion diagnosed in the first/second trimester increased from 47% in 2000/01 (83/178) to 73% (776/1060) in 2006/07 (p < 0.001); intrapartum diagnosis was associated with IDU (Adjusted odds ratio 4.38; 95%CI 3.19–6.02). The percentage of women not receiving any antiretroviral prophylaxis declined from 18% (36/205) in 2001 to 7% in 2007 (61/843) (p < 0.001). Use of sdNVP alone substantially declined after 2003, with a concomitant increase in zidovudine prophylaxis. Median antenatal zidovudine prophylaxis duration increased from 24 to 72 days between 2000 and 2007. Elective caesarean section (CS) rates were relatively stable over time and 34% overall. Mother-to-child transmission (MTCT) rates decreased from 15.2% in 2001 (95%CI 10.2–21.4) to 7.0% in 2006 (95%CI 2.6–14.6). In adjusted analysis, MTCT risk was reduced by 43% with elective CS versus vaginal delivery and by 75% with zidovudine versus no prophylaxis. There have been substantial improvements in use of PMTCT interventions in Ukraine, including earlier diagnosis of HIV-infected pregnant women and increasing coverage with antiretroviral prophylaxis and the initial MTCT rate has more than halved. Future research should focus on hard-to-reach populations such as IDU and on missed opportunities for further reducing the MTCT rate.
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