What will it take to achieve virtual elimination of mother-to-child transmission of HIV? An assessment of current progress and future needs
What will it take to achieve virtual elimination of mother-to-child transmission of HIV? An assessment of current progress and future needs
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DOI：
10.1136/sti.2010.045989
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发表时间：
2010-12-01
影响因子：
3.6
通讯作者：
Shaffer, Nathan
中科院分区：
文献类型：
--
作者：
Mahy, Mary;Stover, John;Shaffer, Nathan
背景HIV阳性孕妇接受抗逆转录病毒药物(ARV)预防母婴传播(MTCT)的人数迅速增加。目的估计过去10年预防母婴传播(MTCT)导致的新发儿童HIV感染的减少。为了预测2010至2015年间实施世卫组织新的母婴传播指南的潜在影响，并考虑为几乎消除母婴传播所需的努力，母婴传播的定义是到2015年将艾滋病毒母婴传播的5%或幼儿感染减少90%。方法利用艾滋病毒阳性孕妇人数最多的25个国家的数据，创建5种情景来评估不同的母婴传播干预措施。结果2000-2009年间，这25个国家每年估计的儿童新感染人数减少了24%，其中约三分之一发生在2009年。如果这些国家在2010至2015年间执行世卫组织防止母婴传播的新建议，并为90%的艾滋病毒阳性孕妇提供更有效的抗逆转录病毒预防或治疗，到2015年可避免100万新的儿童感染。减少育龄妇女的艾滋病毒发病率，消除目前未得到满足的计划生育需求，并将母乳喂养持续时间限制在12个月(通过抗逆转录病毒感染预防)可以避免额外的264 000例感染，导致2009至2015年间每年新的儿童感染总数减少79%，接近但仍未达到几乎消除母婴传播的目标。讨论预防母婴传播方案必须实现更有效的抗逆转录病毒干预措施和更安全的婴儿喂养做法的高覆盖率。此外，还需要采取综合办法，包括满足未得到满足的计划生育需求和减少育龄妇女新的艾滋病毒感染。
Background The number of HIV-positive pregnant women receiving antiretroviral drugs (ARVs) to prevent mother-to-child transmission (MTCT) of HIV has increased rapidly.Objective To estimate the reduction in new child HIV infections resulting from prevention of MTCT (PMTCT) over the past decade. To project the potential impact of implementing the new WHO PMTCT guidelines between 2010 and 2015 and consider the efforts required to virtually eliminate MTCT, defined as < 5% transmission of HIV from mother to child, or 90% reduction of infections among young children by 2015.Methods Data from 25 countries with the largest numbers of HIV-positive pregnant women were used to create five scenarios to evaluate different PMTCT interventions. A demographic model, Spectrum, was used to estimate new child HIV infections as a measure of the impact of interventions.Results Between 2000 and 2009 there was a 24% reduction in the estimated annual number of new child infections in the 25 countries, of which about one-third occurred in 2009 alone. If these countries implement the new WHO PMTCT recommendations between 2010 and 2015, and provide more effective ARV prophylaxis or treatment to 90% of HIV-positive pregnant women, 1 million new child infections could be averted by 2015. Reducing HIV incidence in reproductive age women, eliminating the current unmet need for family planning and limiting the duration of breastfeeding to 12 months (with ARV prophylaxis) could avert an additional 264 000 infections, resulting in a total reduction of 79% of annual new child infections between 2009 and 2015, approaching but still missing the goal of virtual elimination of MTCT.Discussion To achieve virtual elimination of new child infections PMTCT programmes must achieve high coverage of more effective ARV interventions and safer infant feeding practices. In addition, a comprehensive approach including meeting unmet family planning needs and reducing new HIV infections among reproductive age women will be required.