Coverage of Nevirapine-Based Services to Prevent Mother-to-Child HIV Transmission in 4 African Countries
Coverage of Nevirapine-Based Services to Prevent Mother-to-Child HIV Transmission in 4 African Countries
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DOI：
10.1001/jama.2010.990
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发表时间：
2010-07-21
影响因子：
120.7
通讯作者：
Stringer, Jeffrey S. A.
中科院分区：
文献类型：
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作者：
Stringer, Elizabeth M.;Ekouevi, Didier K.;Stringer, Jeffrey S. A.
背景 很少有研究客观评估预防人类免疫缺陷病毒 (HIV) 母婴传播的服务覆盖率。目的 衡量 4 个非洲国家预防艾滋病毒母婴传播服务的覆盖率。设计、设置和患者 使用 2007 年 6 月 10 日至 2008 年 10 月 30 日期间从 43 个随机选择的机构（分组为25 个服务集群）在喀麦隆、科特迪瓦、南非和赞比亚提供送货服务。所有研究中心至少使用单剂量奈韦拉平来预防艾滋病毒母婴传播，部分研究中心使用额外的预防药物。 主要结果指标 人群奈韦拉平覆盖率，定义为样本中母亲摄入奈韦拉平（通过脐带血色谱证实）和婴儿摄入奈韦拉平（通过直接观察证实）的 HIV 暴露婴儿的比例。 结果 总共检测了 27 893 份脐带血标本，其中 3324 人 HIV 血清阳性（12%）。 3196 对 HIV 血清阳性母婴的脐带血奈韦拉平结果的完整数据可用。奈韦拉平覆盖率因地点而异（范围：0%-82%）。根据国家/地区进行调整后，总体覆盖率估计为 51%（95% 置信区间 [CI]，49%-53%）。在多变量分析中，基于奈韦拉平的服务覆盖失败与 20 岁以下的产妇年龄（调整后优势比 [AOR]，1.44；95% CI，1.18-1.76）和 20 至 25 岁的产妇年龄（AOR，1.28；95% CI，1.07-1.54）与 30 岁以上的产妇年龄显着相关； 1 次或更少的产前保健就诊（AOR，2.91；95% CI，2.40-3.54）、2 或 3 次产前保健就诊（AOR，1.93；95% CI，1.60-2.33）以及 4 或 5 次产前保健就诊（AOR，1.56；95% CI，1.34-1.80）与 6 或更多产前护理就诊；阴道分娩（AOR，1.22；95% CI，1.03-1.44）与剖腹产分娩；婴儿出生体重低于 2500 克（AOR，1.34；95% CI，1.11-1.62）对比出生体重为 3500 克或以上。 结论 在对提供预防艾滋病毒母婴传播服务的地点进行随机抽样时，只有 51% 的艾滋病毒暴露婴儿接受了单剂量奈韦拉平的最低限度治疗方案。贾马。 2010;304(3):293-302 www.jama.com
Context Few studies have objectively evaluated the coverage of services to prevent transmission of human immunodeficiency virus (HIV) from mother to child.Objective To measure the coverage of services to prevent mother-to-child HIV transmission in 4 African countries.Design, Setting, and Patients Cross-sectional surveillance study of mother-infant pairs using umbilical cord blood samples collected between June 10, 2007, and October 30, 2008, from 43 randomly selected facilities (grouped as 25 service clusters) providing delivery services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. All sites used at least single-dose nevirapine to prevent mother-to-child HIV transmission and some sites used additional prophylaxis drugs.Main Outcome Measure Population nevirapine coverage, defined as the proportion of HIV-exposed infants in the sample with both maternal nevirapine ingestion (confirmed by cord blood chromatography) and infant nevirapine ingestion (confirmed by direct observation).Results A total of 27 893 cord blood specimens were tested, of which 3324 were HIV seropositive (12%). Complete data for cord blood nevirapine results were available on 3196 HIV-seropositive mother-infant pairs. Nevirapine coverage varied significantly by site (range: 0%-82%). Adjusted for country, the overall coverage estimate was 51% (95% confidence interval [CI], 49%-53%). In multivariable analysis, failed coverage of nevirapine-based services was significantly associated with maternal age younger than 20 years (adjusted odds ratio [AOR], 1.44; 95% CI, 1.18-1.76) and maternal age between 20 and 25 years (AOR, 1.28; 95% CI, 1.07-1.54) vs maternal age of older than 30 years; 1 or fewer antenatal care visits (AOR, 2.91; 95% CI, 2.40-3.54), 2 or 3 antenatal care visits (AOR, 1.93; 95% CI, 1.60-2.33), and 4 or 5 antenatal care visits (AOR, 1.56; 95% CI, 1.34-1.80) vs 6 or more antenatal care visits; vaginal delivery (AOR, 1.22; 95% CI, 1.03-1.44) vs cesarean delivery; and infant birth weight of less than 2500 g (AOR, 1.34; 95% CI, 1.11-1.62) vs birth weight of 3500 g or greater.Conclusion In this random sampling of sites with services to prevent mother-to-child HIV transmission, only 51% of HIV-exposed infants received the minimal regimen of single-dose nevirapine. JAMA. 2010;304(3):293-302 www.jama.com