Vulnerable at Each Step in the PMTCT Care Cascade: High Loss to Follow Up During Pregnancy and the Postpartum Period in Tanzania
Vulnerable at Each Step in the PMTCT Care Cascade: High Loss to Follow Up During Pregnancy and the Postpartum Period in Tanzania
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DOI：
10.1007/s10461-018-2298-8
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发表时间：
2019-07-01
影响因子：
4.4
通讯作者：
Mmbaga, Blandina T.
中科院分区：
文献类型：
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作者：
Cichowitz, Cody;Mazuguni, Festo;Mmbaga, Blandina T.
2013年，坦桑尼亚通过了世界卫生组织关于预防艾滋病毒母婴传播的备选方案B+准则，据此，所有感染艾滋病毒的孕妇开始终身抗逆转录病毒治疗。本研究考察了在护理连续体的关键时刻预防母婴传播的保留情况。这是一项回顾性研究，对坦桑尼亚一组妇女在B+方案第一年参加预防母婴传播的患者数据进行研究。保留在护理中描述了三个时期：(1)第一个月的产前护理（ANC），(2)怀孕，(3)产后期间。采用Logistic回归方法确定与ANC第一个月随访损失（LTFU）相关的因素。生存分析用于确定与妊娠期和产后LTFU相关的因素。650名参与者被纳入队列；262例（40.3%）新诊断为艾滋病毒感染者。产后2年，383/650例（58.7%）为LTFU。在383例LTFU中，73例（19.1%）在分娩第一个月丢失，44例（11.5%）在妊娠期间丢失，266例（69.5%）在分娩后丢失。新诊断的HIV预示着ANC第一个月的LTFU更高（aOR 1.76; 95% CI 1.06-2.94），产后达到LTFU的时间更快（调整相对时间，0.68;95% CI 0.51-0.89）。高LTFU发生在预防母婴传播连续体中，包括刚加入ANC和产后。需要进行持续的研究，以鼓励接受治疗并在分娩后持续参与。
In 2013, Tanzania adopted the World Health Organization's Option B+ guidelines for prevention of mother-to-child transmission of HIV (PMTCT), whereby all HIV-infected pregnant women initiate lifelong antiretroviral therapy. This study examined retention in PMTCT across critical junctures in the care continuum. This was a retrospective study of patient-level data for a cohort of women enrolled in PMTCT during the first year of Option B+ in Tanzania. Retention in care was described across three periods: (1) the first month of antenatal care (ANC), (2) pregnancy, and (3) the postpartum period. Logistic regression was used to identify factors associated with loss to follow up (LTFU) during the first month of ANC. Survival analyses were used to identify factors associated with LTFU during pregnancy and the postpartum periods. 650 participants were included in the cohort; 262 (40.3%) were newly diagnosed with HIV. Two years after delivery, 383/650 (58.7%) were LTFU. Of the 383 LTFU, 73 (19.1%) were lost during the first month of ANC, 44 (11.5%) during pregnancy, and 266 (69.5%) after delivery. Being newly diagnosed with HIV predicted higher LTFU during the first month of ANC (aOR 1.76; 95% CI 1.06-2.94) and faster time to LTFU during the postpartum period (adjusted relative time, 0.68; 95% CI 0.51-0.89). High LTFU occurred across the PMTCT continuum, including immediately after enrollment into ANC and the postpartum period. Ongoing research is needed to encourage treatment uptake and sustained engagement after delivery.