Effectiveness of intensive prevention and control of mother to child transmission of AIDS in Liangshan, Sichuan
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摘要:
目的 评估四川省凉山彝族自治州(凉山州)艾滋病防治和健康扶贫攻坚期间预防艾滋病母婴传播防治模式的实施效果。 方法 对2010—2021年全州孕产妇HIV抗体检测情况和HIV感染孕产妇及所生儿童干预措施落实情况进行调查,收集和分析凉山州启动艾滋病防治和健康扶贫攻坚行动前后预防艾滋病母婴传播相关指标的变化情况。 结果 预防艾滋病母婴传播攻坚防治模式实施后,凉山州和4个重点县艾滋病母婴传播率呈逐年下降趋势(Ρ<0.05),感染孕产妇的孕早期抗病毒用药率、病毒载量检测率、CD4+T淋巴细胞检测率和满18月龄儿童全程随访率呈上升趋势,平均每年分别增加20.31%、27.03%、20.10%、7.78%(Ρ<0.05),孕产妇HIV抗体检测率、感染孕产妇住院分娩率、抗病毒用药率和所生儿童抗病毒用药率、6月龄内儿童早期诊断率、满18月龄儿童HIV抗体检测率在攻坚防治模式实施前均呈上升趋势,实施后除满18月龄儿童HIV抗体检测率未发生变化,也无逐年变化趋势(Ρ>0.05)外,其余各项平均每年分别增加0.13%、1.83%、0.70%、1.09%、3.89%(Ρ<0.05)。 结论 凉山州预防艾滋病母婴传播攻坚防治模式有效控制了艾滋病母婴传播,预防艾滋病母婴传播工作质量和水平得到有效改善。 Abstract:Objective To evaluate the effect of intensive prevention and control of mother to child transmission of AIDS in the project of poverty alleviation through AIDS prevention and control in Liangshan prefecture, Sichuan province. Methods The HIV antibody test results of pregnant women, intervention results in HIV-infected mothers and their children were collected to analyze the changes of indicators related to the prevention and control of mother to child transmission of AIDS during this period from 2010 to 2021 in Liangshan. Results After the implementation of the project in Liangshan, the rate of mother to child transmission of HIV in four key counties and Liangshan decreased year by year (Ρ<0.05), the average annual antiviral drug use rate in the early phase, the viral load detection rate , the CD4 T lymphocytes detection rate of HIV-infected mothers, the follow up rate in children over 18 months increased by 20.31%, 27.03%, 20.10% and 7.78% respectively (Ρ<0.05). The HIV antibody detection rate in pregnant women, the hospital delivery rate in HIV-infected mothers, the antiviral drug use rate in HIV-infected mothers, the antiviral drug use rate in children mothered by HIV-infected women, the early diagnosis rate within 6 months after birth, and the HIV antibody detection rate in children over 18 months all showed an upward trend before the implementation of the project (Ρ<0.05). After the implementation of the project, except the HIV antibody detection rate in children over 18 months which had no change or increased year by year trend (Ρ>0.05), the other items had average annual increases of 0.13%, 1.83%, 0.70%, 1.09%, 3.89% respectively. (Ρ<0.05). Conclusion The intensive prevention and control of AIDS has effectively controlled mother to child transmission of HIV and improved the quality and level of preventing mother to child transmission of HIV in Liangshan. -
表 1 2010-2021年凉山州不同地区HIV感染孕产妇基本特征
Table 1. Basic characteristics of HIV-infected mothers in different areas of Liangshan, 2010−2021
基本特征 4个重点县 13个非重点县 基本特征 4个重点县 13个非重点县 例数 构成比(%) 例数 构成比(%) 例数 构成比(%) 例数 构成比(%) 年龄组(岁) 职业 0~ 146 1.99 82 4.02 农民 7 077 96.67 1 877 92.01 20~ 3 418 46.69 1 113 54.56 农民工 158 2.16 44 2.16 30~ 2 160 29.51 513 25.15 家务及待业 32 0.43 57 2.79 35~ 1 597 21.81 332 16.27 其他 54 0.74 62 3.04 婚姻状况 文化程度 未婚 55 0.75 38 1.86 文盲/半文盲 6 707 91.61 1 372 67.25 初婚 6 690 91.38 1 612 79.02 小学 546 7.46 431 21.13 再婚 537 7.34 350 17.16 初中 38 0.52 157 7.70 同居/离婚/丧偶 39 0.53 40 1.96 高中及以上 30 0.41 80 3.92 民族 HIV感染途径 彝族 7 262 99.19 1 883 92.30 性传播 6 236 85.18 1 657 81.23 汉族 25 0.34 135 6.62 其他 744 10.16 66 3.23 其他 34 0.47 22 1.08 不详 341 4.66 317 15.54 孕次 现有子女数 1 1 201 16.41 425 20.83 0~1 2 920 39.89 1 168 57.25 2~3 4 195 57.30 1 112 54.51 2~3 3 681 50.28 807 39.56 ≥4 1 925 26.29 503 24.66 ≥4 720 9.83 65 3.19 本次妊娠前已知感染 妊娠前已知感染后的妊娠次数 知道 4 456 60.87 1 019 49.95 1 1 687 37.86 356 34.94 不知道 1 732 23.66 712 34.90 2 1 790 40.17 482 47.30 不清楚 1 133 15.47 309 15.15 ≥3 979 21.97 181 17.76 表 2 凉山州艾滋病母婴传播率
Table 2. Rate of mother to child transmission of HIV in Liangshan
年份 凉山州 4个重点县 2016(基线) 9.02(37.45/415) 8.88(28.50/321) 2017-2018 5.92(84.24/1 423) 6.19(66.10/1 067) 2019-2020 4.10(95.32/2 325) 4.25(74.77/1 760) 2021 2.85(35.41/1 242) 2.99(29.87/999) 注:括号外数据为艾滋病母婴传播率(%),括号内数据为HIV感染产妇所生儿童中18月龄诊断为HIV感染人数/HIV感染产妇所生满18月龄儿童人数 表 3 2016-2021年凉山州不同地区预防艾滋病母婴传播主要过程指标
Table 3. Main indicators of prevention and control of mother to child transmission of AIDS in different areas of Liangshan 2016−2021
年份 地区 孕产妇
HIV抗体
检测率
(%)住院
分娩率
(%)抗病毒
用药率
(%)感染孕产妇 6月龄内
儿童早期
诊断率
(%)满18月龄
儿童HIV
抗体检测率
(%)满18月龄
儿童全程
随访率
(%)孕早期抗病毒
用药率(%)病毒载量
检测率(%)CD4+T淋巴
细胞检测率(%)所生儿童抗病
毒用药率(%)2016 4个重点县 93.41 95.18 92.37 12.05 0.00 0.20 97.98 73.13 81.76 50.00 13个非重点县 96.64 92.34 93.78 6.22 0.96 4.31 91.50 87.16 59.84 91.74 2017 4个重点县 95.73 97.13 97.45 21.97 0.16 26.11 95.85 82.71 82.44 60.95 13个非重点县 98.20 91.03 95.73 31.20 14.96 23.50 96.97 89.64 60.78 87.58 2018 4个重点县 97.68 94.65 99.39 41.31 0.61 25.76 96.58 84.80 92.89 68.60 13个非重点县 99.70 96.03 98.19 32.13 22.38 24.55 97.51 93.07 92.69 88.58 2019 4个重点县 98.91 99.77 100.00 91.47 57.34 56.77 100.00 95.27 98.62 84.69 13个非重点县 99.92 100.00 100.00 90.67 79.11 84.89 100.00 97.53 100.00 92.91 2020 4个重点县 99.35 99.89 100.00 97.24 90.50 87.40 100.00 98.61 99.18 90.79 13个非重点县 99.99 99.55 100.00 95.02 95.93 95.48 100.00 99.08 100.00 97.08 2021 4个重点县 99.04 99.90 100.00 97.20 97.00 94.62 100.00 98.73 98.07 96.67 13个非重点县 99.86 100.00 100.00 96.73 95.10 92.24 100.00 96.92 97.82 98.69 表 4 2010-2021年凉山州预防艾滋病母婴传播中断时间序列多重线性回归分析
Table 4. Multiple regression analysis results of time series of interrupting mother to child transmission of AIDS in Liangshan, 2010-2021
过程指标 常量 常量的Ρ值 β1 β1的Ρ值 β2 β2的Ρ值 β3 β3的Ρ值 孕产妇HIV抗体检测率 51.062 0.000 7.119 0.000 47.194 0.036 −6.988 0.014 感染孕产妇住院分娩率 55.100 0.000 6.291 0.000 24.403 0.004 −4.457 0.000 感染孕产妇抗病毒用药率 44.677 0.000 7.505 0.000 47.587 0.003 −6.810 0.001 感染孕产妇孕早期抗病毒用药率 −0.589 0.947 1.590 0.430 −132.733 0.004 18.716 0.001 感染孕产妇病毒载量检测率 −0.509 0.952 0.247 0.895 −217.777 0.000 26.786 0.000 感染孕产妇CD4+T淋巴细胞检测率 −5.866 0.374 2.471 0.114 −135.836 0.001 17.629 0.000 感染孕产妇所生儿童抗病毒用药率 60.576 0.000 5.578 0.000 27.138 0.019 −4.490 0.002 6月龄内儿童早期诊断率 −5.574 0.083 11.490 0.000 59.546 0.001 −7.596 0.000 满18月龄儿童HIV抗体检测率 24.904 0.004 5.444 0.009 37.423 0.086 −1.818 0.460 满18月龄儿童全程随访率 52.995 0.000 0.288 0.740 −39.571 0.007 7.496 0.001 -
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