Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya.
Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya.
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DOI：
10.1080/09540121.2017.1400642
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发表时间：
2018-01-01
期刊：
影响因子：
1.7
通讯作者：
John-Stewart, G. C.
中科院分区：
文献类型：
--
作者：
McGrath, C. J.;Singa, B.;John-Stewart, G. C.
卫生工作者的经验和社区的支持可能会更高的艾滋病毒高流行率地区比低流行率地区，导致改善预防母婴传播艾滋病毒（PMTCT）计划。我们评估了6周和9个月的婴儿艾滋病毒传播的风险（TR）在高流行地区和全国。人口比例的大小抽样被用来选择141个诊所在肯尼亚，和移动的小组调查母婴对参加6周和9个月的免疫接种。对接触艾滋病毒的婴儿进行了艾滋病毒DNA检测。在全国调查的2 521对母婴中，2 423对（94.7%）报告在怀孕或先前诊断时进行了艾滋病毒检测，其中200人（7.4%）感染艾滋病毒，188名婴儿接受了艾滋病毒检测。6周和9个月队列的TR分别为8.8%（4.0%-18.3%）和8.9%（3.2%-22.2%），包括产后诊断为HIV的母亲，其中53%的婴儿感染是由于先前未诊断的母亲。在尼扬扎调查的276名艾滋病毒暴露婴儿中，6周时的TR为1.4%（0.4%-5.3%），9个月时为5.1%（2.5%-9.9%）。总体而言，艾滋病毒高发区尼扬扎的TR低于全国（3.3%对7.2%，P=0.02）。在两项调查中，未向男性伴侣披露艾滋病毒和不完整的抗逆转录病毒药物与TR相关[aOR=12.8（3.0-54.3）; aOR=5.6（1.2-27.4）; aOR=4.5（1.0-20.0），aOR=2.5，（0.8-8.4）]。在艾滋病毒高流行率地区，抗逆转录病毒治疗完成情况和伴侣艾滋病毒信息披露情况较好，TR较低，这可能是由于方案效率或社区/同行/伙伴的支持。大多数9个月感染者的母亲事先没有艾滋病毒诊断。检测偶发或未确诊的孕产妇感染的战略对于实现防止母婴传播至关重要。
Health worker experience and community support may be higher in high HIV prevalence regions than low prevalence regions, leading to improved prevention of mother-to-child HIV transmission (PMTCT) programs. We evaluated 6-week and 9-month infant HIV transmission risk (TR) in a high prevalence region and nationally. Population-proportionate-to-size sampling was used to select 141 clinics in Kenya, and mobile teams surveyed mother-infant pairs attending 6-week and 9-month immunizations. HIV DNA testing was performed on HIV-exposed infants. Among 2521 mother-infant pairs surveyed nationally, 2423 (94.7%) reported HIV testing in pregnancy or prior diagnosis, of whom 200 (7.4%) were HIV-infected and 188 infants underwent HIV testing. TR was 8.8% (4.0%-18.3%) in 6-week and 8.9% (3.2%-22.2%) in 9-month cohorts including mothers with HIV diagnosed postpartum, of which 53% of infant infections were due to previously undiagnosed mothers. Of 276 HIV-exposed infants in the Nyanza survey, TR was 1.4% (0.4%-5.3%) at 6-week and 5.1% (2.5%-9.9%) at 9-months. Overall TR was lower in Nyanza, high HIV region, than nationally (3.3% vs. 7.2%, P=0.02). HIV non-disclosure to male partners and incomplete ARVs were associated with TR in both surveys [aOR=12.8 (3.0-54.3); aOR=5.6 (1.2-27.4); aOR=4.5 (1.0-20.0), aOR=2.5, (0.8-8.4), respectively]. TR was lower in a high HIV prevalence region which had better ARV completion and partner HIV disclosure, possibly due to programmatic efficiencies or community/peer/partner support. Most 9-month infections were among infants of mothers without prior HIV diagnosis. Strategies to detect incident or undiagnosed maternal infections will be important to achieve PMTCT.