PURPOSE:We assessed 18-month cumulative mother-to-child HIV transmission (MTCT) risk and risk factors for no antiretroviral medication use during pregnancy among adolescent, young women, and adult mothers in Zimbabwe. METHODS:We analyzed data from a prospective survey of 1,171 mother-infant pairs with HIV-exposed infants aged 4-12 weeks who were recruited from 151 immunization clinics from February to August 2013. HIV-exposed infants were followed until diagnosed with HIV, death, or age 18 months. Findings were weighted and adjusted for complex survey design and nonresponse. RESULTS:The 18-month cumulative MTCT risk was highest among adolescent aged ≤19 years (12%) followed by young women aged 20-24 years (7.5%) and adult women aged ≥25 years (6.9%). Across these groups, more than 94% had ≥1 antenatal care visit by 21 weeks of gestation, more than 95% had ≥1 HIV test, and more than 98% knew their HIV status. Of known HIV-positive mothers, maternal antiretroviral medication coverage during pregnancy was 76.8% (95% confidence interval: 65.1-85.5), 83.8% (78.6-87.9), and 87.8% (84.6-90.4) among adolescent, young women, and adult mothers, respectively. Among HIV-positive mothers diagnosed prenatally, the adjusted odds ratio of no ARV use during pregnancy was increased among those who had no antenatal care attendance (adjusted odds ratio: 7.7 [3.7-16.0]), no HIV testing (7.3 [2.3-23.5]), no prepartum CD4 count testing (2.1 [1.3-3.4]), and maternal HIV identification during pregnancy (2.9 [1.8-4.8]). Age was not a risk factor. CONCLUSIONS:With similar coverage of prevention of MTCT services, the 18-month cumulative MTCT risk was higher among adolescents and young women, compared with adults. Additional research should examine the causes to develop targeted interventions.

译文

目的:我们评估了津巴布韦的青少年,年轻妇女和成年母亲在怀孕期间未使用抗逆转录病毒药物的18个月累积母婴HIV传播(MTCT)风险和危险因素。
方法:我们分析了2013年2月至2013年8月从151个免疫诊所招募的1,171对4-12周暴露于HIV的母婴对的前瞻性调查数据。或18岁以下的年龄。对结果进行加权,并针对复杂的调查设计和不答复进行调整。
结果:≤19岁的青少年中18个月累积MTCT风险最高(12%),其次是20-24岁的年轻女性(7.5%)和≥25岁的成年女性(6.9%)。在这些人群中,超过21%的孕妇在21周前接受了≥1次产前检查,超过95%的患者接受了≥1次HIV检测,超过98%的人知道自己的HIV状况。在已知的HIV阳性母亲中,孕期孕妇的抗逆转录病毒药物覆盖率分别为76.8%(95%置信区间:65.1-85.5),83.8%(78.6-87.9)和87.8%(84.6-90.4),分别为青少年,年轻妇女和成年母亲。在产前诊断为艾滋病毒阳性的母亲中,没有进行产前护理的妇女中,未怀孕期间未使用抗逆转录病毒的调整比值比有所增加(调整比值比:7.7 [3.7-16.0]),没有进行艾滋病毒检测(7.3 [2.3-23.5]) ]),未进行产前CD4计数测试(2.1 [1.3-3.4]),孕妇在怀孕期间进行了HIV鉴定(2.9 [1.8-4.8])。年龄不是危险因素。
结论:在预防MTCT服务的覆盖范围相似的情况下,与成年人相比,青少年和年轻妇女的18个月累积MTCT风险更高。其他研究应检查制定针对性干预措施的原因。

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