First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa.
First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa.
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DOI：
10.1136/jech-2014-204535
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发表时间：
2015-03
影响因子：
6.3
通讯作者：
South Africa PMTCT Evaluation Team
中科院分区：
文献类型：
--
作者：
Goga AE;Dinh TH;Jackson DJ;Lombard C;Delaney KP;Puren A;Sherman G;Woldesenbet S;Ramokolo V;Crowley S;Doherty T;Chopra M;Shaffer N;Pillay Y;South Africa PMTCT Evaluation Team
在艾滋病毒高流行率和资源有限的环境中，缺乏关于预防母婴传播(母婴传播)方案在国家人口一级的有效性的数据。我们评估了2010年防止母婴传播对南非(SA)的影响。一项以设施为基础的调查采用分层多阶段整群抽样设计。从565家诊所招募了具有全国代表性的10名 178名4-8 周婴儿的样本。数据收集包括照顾者访谈、记录审查和婴儿干血斑点，以确定暴露于艾滋病毒的婴儿(HEI)和感染艾滋病毒的婴儿。在分析期间，自我报告的抗逆转录病毒的使用被分类：1a：三联抗逆转录病毒治疗；1b：叠氮胸苷和GT；10 周；2a：azidothymine≤10 周；2b：不完全抗逆转录病毒预防；3a：没有产前抗逆转录病毒；3b：缺失抗逆转录病毒信息。研究结果针对无反应、调查设计和活产分布进行了调整。在全国范围内，32%的活婴为HEI；早期母婴传播(MTCT)为3.5%(95%可信区间为2.9%至4.1%)。总共有29.4%的HEI出生于接受三联ARV治疗(1a类)的母亲，55.6%的母亲接受预防(1b，2a，2b)，9.5%的母亲产前未接受ARV(3a)，5.5%的母亲缺少ARV信息(3b)。控制其他因素组，1b和2a的MTCT与1a相似(参考：调整OR(AOR)为1b，0.98，0.52至1.83；2a，1.31，0.69至2.48)。2b组MTCT较高(AOR 3.68，1.69~7.97)。在3a组中，纯母乳喂养、混合母乳喂养和非母乳喂养母亲的早期母婴传播最高，分别为11.50%(4.67%~18.33%)、11.90%(7.45%~16.35%)和3.45%(0.53%~6.35%)。抗逆转录病毒治疗或预防10 周可消除这种差异(MTCT3.94%，1.98%至5.90%；2.07%，0.55%至3.60%；2.11%，1.28%至2.95%)。南非，一个高艾滋病毒流行率的中等收入国家，在产后4-8 周达到5%的母婴传播率。防止母婴传播对无艾滋病毒生存的长期影响需要紧急评估。
There is a paucity of data on the national population-level effectiveness of preventing mother-to-child transmission (PMTCT) programmes in high-HIV-prevalence, resource-limited settings. We assessed national PMTCT impact in South Africa (SA), 2010. A facility-based survey was conducted using a stratified multistage, cluster sampling design. A nationally representative sample of 10 178 infants aged 4–8 weeks was recruited from 565 clinics. Data collection included caregiver interviews, record reviews and infant dried blood spots to identify HIV-exposed infants (HEI) and HIV-infected infants. During analysis, self-reported antiretroviral (ARV) use was categorised: 1a: triple ARV treatment; 1b: azidothymidine >10 weeks; 2a: azidothymidine ≤10 weeks; 2b: incomplete ARV prophylaxis; 3a: no antenatal ARV and 3b: missing ARV information. Findings were adjusted for non-response, survey design and weighted for live-birth distributions. Nationally, 32% of live infants were HEI; early mother-to-child transmission (MTCT) was 3.5% (95% CI 2.9% to 4.1%). In total 29.4% HEI were born to mothers on triple ARV treatment (category 1a) 55.6% on prophylaxis (1b, 2a, 2b), 9.5% received no antenatal ARV (3a) and 5.5% had missing ARV information (3b). Controlling for other factors groups, 1b and 2a had similar MTCT to 1a (Ref; adjusted OR (AOR) for 1b, 0.98, 0.52 to 1.83; and 2a, 1.31, 0.69 to 2.48). MTCT was higher in group 2b (AOR 3.68, 1.69 to 7.97). Within group 3a, early MTCT was highest among breastfeeding mothers 11.50% (4.67% to 18.33%) for exclusive breast feeding, 11.90% (7.45% to 16.35%) for mixed breast feeding, and 3.45% (0.53% to 6.35%) for no breast feeding). Antiretroviral therapy or >10 weeks prophylaxis negated this difference (MTCT 3.94%, 1.98% to 5.90%; 2.07%, 0.55% to 3.60% and 2.11%, 1.28% to 2.95%, respectively). SA, a high-HIV-prevalence middle income country achieved <5% MTCT by 4–8 weeks post partum. The long-term impact on PMTCT on HIV-free survival needs urgent assessment.
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DOI：
10.1097/00126334-200311010-00003
发表时间：
2003-11-01
影响因子：
3.6
作者：
Ayouba, A;Tene, G;Nerrienet, E
通讯作者：
Nerrienet, E
影响因子：
158.5
作者：
Lallemant, M;Jourdain, G;Thaineua, V
通讯作者：
Thaineua, V
影响因子：
3.6
作者：
Creek, Tracy;Tanuri, Amilcar;Shaffer, Nathan
通讯作者：
Shaffer, Nathan
影响因子：
3.8
作者：
Rollins, Nigel;Mzolo, Similo;van Rooyen, Heidi
通讯作者：
van Rooyen, Heidi
影响因子：
168.9
作者：
Chantler, C
通讯作者：
Chantler, C