The impact of free antiretroviral therapy for pregnant non-citizens and their infants in Botswana.
The impact of free antiretroviral therapy for pregnant non-citizens and their infants in Botswana.
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DOI：
10.1002/jia2.26161
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发表时间：
2023-10
影响因子：
6
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中科院分区：
文献类型：
--
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2019年12月，博茨瓦纳政府将免费抗逆转录病毒疗法(ART)扩大到非公民。我们评估了这一政策变化对产前护理(ANC)、抗逆转录病毒治疗覆盖率和不良生育结果的影响。特塞帕莫监测研究收集了博茨瓦纳多达18个分娩地点的数据。我们比较了公民和非公民艾滋病毒携带者在抗逆转录病毒治疗扩大前后与非公民的结果。不良分娩结局包括早产37周、极早产32周、小于胎龄10个百分位数、小于胎龄3个百分位数、死产和新生儿死亡。建立了对数二项回归模型来计算风险比。从2014年8月至2021年9月，45576名(96.5%)公民和1513名(3.2%)非公民艾滋病毒携带者分娩；954名(62.9%)非公民分娩在抗逆转录病毒治疗扩大之前，562人(37.1%)在扩大抗逆转录病毒治疗之后。在携带艾滋病毒的孕妇中，非公民的ANC就诊率从扩大前的79.2%增加到扩大后的87.2%(P<；0.001)，并变得与公民更相似(扩大后为96.0%)。接受任何产前抗逆转录病毒治疗的非公民从扩大前的65.5%增加到扩大后的89.9%(p<；0.001)，也更接近于公民(97.2%)。与非本地人相比，非本地人在扩张期出生的独生子女患PTD(ARR=1.28，95%CI，1.11，1.46)、VPTD(ARR=1.89，95%CI，1.43，2.44)和新生儿死亡(ARR=1.69，95%CI，1.03，2.60)的危险性显著增加，而SGA的危险性(ARR=0.75；95%CI，0.62，0.89)明显降低。扩大后，在非公民中观察到大多数不良后果的下降幅度更大，非公民和公民之间的结果基本相似。非公民在PTD(ARR=0.84，95%CI，0.66，1.06)、VPTD(ARR=0.57，95%CI，0.28，1.01)、SGA(ARR=0.91，95%CI，0.72，1.13)、VSGA(ARR=0.87，95%CI，0.58，1.25)、死产(ARR=0.71，95%CI，0.35，1.27)和新生儿死亡(ARR=1.35，95%CI，0.60，2.62)。在将免费抗逆转录病毒治疗扩大到非公民之后，公民和非公民艾滋病毒携带者之间在ANC和孕期使用抗逆转录病毒治疗方面的差距缩小了。不再观察到不良生育结果的差异。
In December 2019, the Botswana government expanded free antiretroviral therapy (ART) to include non‐citizens. We evaluated the impact of this policy change on antenatal care (ANC), antiretroviral therapy coverage and adverse birth outcomes. The Tsepamo Surveillance study collects data at up to 18 delivery sites in Botswana. We compared outcomes in citizens and non‐citizens living with HIV before and after antiretroviral therapy expansion to non‐citizens. Adverse birth outcomes included preterm delivery (PTD) <37 weeks, very preterm delivery (VPTD) <32 weeks, small for gestational age (SGA) <10th percentile, very small for gestational age (VSGA) <3rd percentile, stillbirth and neonatal death. Log‐binomial regression models were constructed to generate risk ratios. From August 2014 to September 2021, 45,576 (96.5%) citizens and 1513 (3.2%) non‐citizens living with HIV delivered; 954 (62.9%) non‐citizen deliveries were before the antiretroviral therapy expansion, and 562 (37.1%) were after. Non‐citizen ANC attendance among pregnant people living with HIV increased from 79.2% pre‐expansion to 87.2% post‐expansion (p<0.001), and became more similar to citizens (96.0% post‐expansion). Non‐citizens receiving any antenatal antiretroviral therapy increased from 65.5% pre‐expansion to 89.9% post‐expansion (p < 0.001), also more similar to citizens (97.2% post‐expansion). Infants born to non‐citizens with singleton gestations in the pre‐expansion period had significantly greater risk of PTD (aRR = 1.28, 95% CI, 1.11, 1.46), VPTD (aRR = 1.89, 95% CI, 1.43, 2.44) and neonatal death (aRR = 1.69, 95% CI, 1.03, 2.60), but reduced SGA risk (aRR = 0.75; 95% CI, 0.62, 0.89) compared with citizens. Post‐expansion, greater declines in most adverse outcomes were observed in non‐citizens, with largely similar outcomes between non‐citizens and citizens. Non‐significant differences were observed for non‐citizenship in PTD (aRR = 0.84, 95% CI, 0.66, 1.06), VPTD (aRR = 0.57, 95% CI, 0.28, 1.01), SGA (aRR = 0.91, 95% CI, 0.72, 1.13), VSGA (aRR = 0.87, 95% CI, 0.58, 1.25), stillbirth (aRR = 0.71, 95% CI, 0.35, 1.27) and neonatal death (aRR = 1.35, 95% CI, 0.60, 2.62). Following the expansion of free antiretroviral therapy to non‐citizens, gaps narrowed in ANC and antiretroviral therapy use in pregnancy between citizens and non‐citizens living with HIV. Disparities in adverse birth outcomes were no longer observed.
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影响因子：
2.9
作者：
Isaacson A;Diseko M;Mayondi G;Mabuta J;Davey S;Mmalane M;Makhema J;Jacobson DL;Luckett R;Shapiro RL;Zash R
通讯作者：
Zash R
影响因子：
1.6
作者：
Marukutira, Tafireyi;Yin, Dwight;Dickinson, Diana
通讯作者：
Dickinson, Diana
影响因子：
7.2
作者：
Hernan, Miguel A.;Sauer, Brian C.;Shrier, Ian
通讯作者：
Shrier, Ian
DOI：
10.1097/qad.0000000000001673
发表时间：
2018-01-02
期刊：
AIDS (London, England)
影响因子：
--
作者：
Caniglia EC;Zash R;Jacobson DL;Diseko M;Mayondi G;Lockman S;Chen JY;Mmalane M;Makhema J;Hernán MA;Shapiro RL
通讯作者：
Shapiro RL
影响因子：
3.4
作者：
Fiore, Simona;Newell, Marie-Louise;Clerici, Mario
通讯作者：
Clerici, Mario