Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit.
Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit.
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DOI：
10.1136/bmjopen-2020-038311
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发表时间：
2020-12-12
期刊：
影响因子：
2.9
通讯作者：
Luchters S
中科院分区：
文献类型：
--
作者：
Kelly-Hanku A;Nightingale CE;Pham MD;Mek A;Homiehombo P;Bagita M;Nankinga J;Vallely A;Vallely L;Sethy G;Kaldor J;Luchters S
尽管很早就通过了世卫组织的指导方针，向确诊为艾滋病毒的孕妇提供终身抗逆转录病毒(ARV)方案，但巴布亚新几内亚的艾滋病毒母婴传播预防方案仍然处于次优状态。感染艾滋病毒的婴儿和没有接受治疗的母亲的数量令人无法接受。这项研究的目的是描述这一方案的特点，并调查与方案执行结果有关的因素。我们对两家提供母婴传播预防服务的医院HIV阳性孕妇的临床资料进行了回顾性分析。在研究期间(2012年6月至2015年6月)参加预防母婴传播方案的所有妇女都有资格参加。在一项儿科ARV计划中，我们使用Logistic回归分析了与出生前和婴儿登记前母体失访(LTFU)相关的因素。763的女性有符合纳入条件的记录。这两个地点的女性之间存在人口统计学和临床差异。近一半(45.1%)的妇女在怀孕前就知道自己的艾滋病毒阳性状态。多因素分析显示，出生时易患下尿路感染的妇女年龄较小(调整后OR=2.92，95%可信区间为1.16~7.63)，最近/最近一次妊娠时新诊断为艾滋病病毒感染者(调整后OR=3.5 0，95% 可信区间为1.62~7.59)，且处于HIV血清不一致关系(调整后OR=2.94，95% 可信区间为1.11~7.84)。登记时初产妇(AOR=3.13，95% CI 1.44~6.8)和最近/最近一次妊娠时新诊断的孕妇(AOR=2.49，95% CI 1.31~4.73)与登记前母体LTFU有关。在763名暴露的婴儿中，有50名(6.6%)HIV DNA检测呈阳性。我们的研究强调了女性LTFU的预测因素。在方案的不同阶段了解这些相互关系，对于更好地支持留守护理的目标和时机提供了重要的见解。
Despite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes. We conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012–June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme. 763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test. Our study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care.
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