Presentation for care and antenatal management of HIV in the UK, 2009-2014.
Presentation for care and antenatal management of HIV in the UK, 2009-2014.
复制标题
DOI：
10.1111/hiv.12410
复制
发表时间：
2017-03
期刊：
影响因子：
3
通讯作者：
Tookey PA
中科院分区：
文献类型：
--
作者：
French CE;Thorne C;Byrne L;Cortina-Borja M;Tookey PA
尽管英国总体艾滋病毒垂直传播率非常低，但较晚开始产前抗逆转录病毒治疗（ART）的女性的感染率较高。我们调查了HIV阳性孕妇护理的关键要素[产前护理预约、HIV实验室评估（CD 4计数和HIV病毒载量）和产前ART启动]的时间，以评估临床实践是否根据建议发生变化，并调查与延迟护理相关的因素。我们使用了2009 - 2014年英国全国妊娠期和儿童期艾滋病毒研究。通过拟合logistic回归和考克斯比例风险模型分析数据。据报告，共有5 693名新生儿，其中79.5%是在怀孕前被诊断出感染艾滋病毒的妇女。产前预约时的中位妊娠期为12.1周[四分位距（IQR）10.0-15.6周]，2012-2014年与2009-2011年相比，预约时间显著提前（P < 0.001），尽管仅在先前诊断的妇女中。总体而言，42.2%的妊娠是在晚期（≥ 13孕周）进行的。在尚未接受治疗的妇女中，产前抗逆转录病毒治疗开始的中位数为21.4（IQR18.1-24.5）周，最近一段时间开始的时间明显更早（P < 0.001）。与既往诊断的妇女相比，本次妊娠期间新诊断的妇女更晚预约产前保健，更晚开始产前抗逆转录病毒治疗（均P < 0.001）。多变量分析显示，在获得或接受护理方面存在人口差异，包括移民和经产妇女在内的群体较晚开始接受护理。虽然妇女在怀孕早期就能获得产前护理和艾滋病毒护理，但有些妇女在及时开始产前护理和抗逆转录病毒疗法方面仍然面临障碍。
Despite very low rates of vertical transmission of HIV in the UK overall, rates are higher among women starting antenatal antiretroviral therapy (ART) late. We investigated the timing of key elements of the care of HIV‐positive pregnant women [antenatal care booking, HIV laboratory assessment (CD4 count and HIV viral load) and antenatal ART initiation], to assess whether clinical practice is changing in line with recommendations, and to investigate factors associated with delayed care. We used the UK's National Study of HIV in Pregnancy and Childhood for 2009−2014. Data were analysed by fitting logistic regression and Cox proportional hazards models. A total of 5693 births were reported; 79.5% were in women diagnosed with HIV prior to that pregnancy. Median gestation at antenatal booking was 12.1 weeks [interquartile range (IQR) 10.0–15.6 weeks] and booking was significantly earlier during 2012–2014 vs. 2009–2011 (P < 0.001), although only in previously diagnosed women. Overall, 42.2% of pregnancies were booked late (≥ 13 gestational weeks). Among women not already on treatment, antenatal ART commenced at a median of 21.4 (IQR18.1–24.5) weeks and started significantly earlier in the most recent time period (P < 0.001). Compared with previously diagnosed women, those newly diagnosed during the current pregnancy booked later for antenatal care and started antenatal ART later (both P < 0.001). Multivariable analyses revealed demographic variations in access to or uptake of care, with groups including migrants and parous women initiating care later. Although women are accessing antenatal and HIV care earlier in pregnancy, some continue to face barriers to timely initiation of antenatal care and ART.