Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya.
Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya.
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DOI：
10.1097/qai.0000000000001176
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发表时间：
2017-01-01
期刊：
影响因子：
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通讯作者：
John-Stewart G
中科院分区：
文献类型：
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作者：
Ronen K;McGrath CJ;Langat AC;Kinuthia J;Omolo D;Singa B;Katana AK;NgʼAngʼA LW;John-Stewart G
青少年的怀孕率和艾滋病毒感染率很高。然而，他们参与预防艾滋病毒母婴传播（PMTCT）服务的情况却很少。我们比较了肯尼亚成年母亲和青少年母亲参与预防母婴传播级联的情况。我们对就诊的 120 家母婴健康诊所的母婴对进行了一项具有全国代表性的横断面调查，这些诊所按照与规模抽样的概率成比例进行选择，并在 30 家诊所对 HIV 阳性母亲进行了二次调查。使用 χ2 检验和逻辑回归对青少年（年龄≤19 岁）和成年母亲的产前护理 (ANC) 出勤率、HIV 检测和抗逆转录病毒 (ARV) 使用情况进行比较。在 2521 名母亲中，278 名（12.8%）是青少年。与成年人相比，青少年就业（16.5% vs. 37.9%）、结婚（66.1% vs. 88.3%）、计划怀孕（40.5% vs. 58.6%）或披露自己的艾滋病病毒感染状况（77.5% vs. 90.7%）的可能性较小（全部 P < 0.01）。与成年人相比，青少年参加 ≥ 4 次 ANC 就诊的可能性较低（35.2% vs. 45.6%，P = 0.002）。在调整就业、家庭拥挤、怀孕意愿、妊娠和艾滋病毒状况后，这种效应仍然显着[调整后的比值比（95%置信区间）= 0.54（0.37至0.97），P = 0.001]。在 2359 名未曾接受过 HIV 检测的女性中，96.1% 在怀孕期间接受了检测；青少年和成人之间的测试水平没有差异。在 288 名怀孕前未接受抗逆转录病毒治疗的 HIV 阳性女性中，青少年服用抗逆转录病毒药物的可能性低于成年人（65.0% vs. 85.8%，P = 0.01）或生育婴儿服用抗逆转录病毒药物（85.7% vs. 97.7%，P = 0.005）。青春期母亲的 ANC 出勤率和抗逆转录病毒药物用于预防母婴传播 (PMTCT) 的使用率较低。需要采取有针对性的干预措施，以提高这一弱势群体在预防母婴传播级联中的保留率。
Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. We conducted a nationally representative cross-sectional survey of mother–infant pairs attending 120 maternal child health clinics selected by probability proportionate to size sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. Antenatal care (ANC) attendance, HIV testing, and antiretroviral (ARV) use were compared between adolescent (age ≤19 years) and adult mothers using χ2 tests and logistic regression. Among 2521 mothers, 278 (12.8%) were adolescents. Adolescents were less likely than adults to be employed (16.5% vs. 37.9%), married (66.1% vs. 88.3%), have intended pregnancy (40.5% vs. 58.6%), or have disclosed their HIV status (77.5% vs. 90.7%) (P < 0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2% vs. 45.6%, P = 0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity, and HIV status [adjusted odds ratio (95% confidence interval) = 0.54 (0.37 to 0.97), P = 0.001]. Among 2359 women without previous HIV testing, 96.1% received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on antiretroviral therapy before pregnancy, adolescents were less likely than adults to be on ARVs (65.0% vs. 85.8%, P = 0.01) or to have infants on ARVs (85.7% vs. 97.7%, P = 0.005). Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade.