Analysis of HIV Early Infant Diagnosis Data to Estimate Rates of Perinatal HIV Transmission in Zambia 英文参考文献.docVIP

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Analysis of HIV Early Infant Diagnosis Data to Estimate Rates of Perinatal HIV Transmission in Zambia 英文参考文献.doc

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Analysis of HIV Early Infant Diagnosis Data to Estimate Rates of Perinatal HIV Transmission in Zambia 英文参考文献

AnalysisofHIVEarlyInfantDiagnosisDatatoEstimate RatesofPerinatalHIVTransmissioninZambia KwasiTorpey1*,JustinMandala1,PriscaKasonde1,GailBryan-Mofya2,MaximillianBweupe3, JonathanMukundu1,ChilunjeZimba1,CatherineMwale1,HilaryLumano2,MichaelWelsh1 1FHI360,Durham,NorthCarolina,UnitedStatesofAmerica,2ManagementSciencesforHealth,Cambridge,Massachusetts,UnitedStatesofAmerica,3MinistryofHealth Zambia,Lusaka,Zambia Abstract Background:Mother-to-childtransmissionofHIV(MTCT)remainsthemostprevalentsourceofpediatricHIVinfection.Most PMTCT(preventionofmother-to-childtransmissionofHIV)programshaveconcentratedmonitoringandevaluationefforts on process rather than on outcome indicators. In this paper, we review service data from 28,320 children born to HIV- positivemotherstoestimateMTCTrates. Method:ThisstudyanalyzedDNAPCRresultsandPMTCTdatafromperinatallyexposedchildrenzeroto12monthsofage fromfiveZambianprovincesbetweenSeptember2007andJuly2010. Results: The majority of children (58.6%) had a PCR test conducted between age six weeks and six months. Exclusive breastfeeding(56.8%)wasthemostfrequentfeedingmethod.Anestimated45.9%ofmotherswerebelow30yearsoldand 93.3%haddisclosedtheirHIVstatus.IntermsofARVregimenforPMTCT,32.7%receivedAZT+singledoseNVP(sdNVP), 30.9% received highly active antiretroviral treatment (HAART), 19.6% received sdNVP only and 12.9% received no ARVs. TransmissionratesatsixweekswhenARVswerereceivedbybothmotherandbaby,motheronly,babyonly,andnonewere 5.8%,10.5%,15.8%and21.8%respectively.TransmissionratesatsixweekswheremotherreceivedHAART,AZT+sdNVP, sdNVP, and no intervention were 4.2%, 6.8%, 8.7% and 20.1% respectively. Based on adjusted analysis including ARV exposuresandnonARV-relatedparameters,lowerratesofpositivePCRresultswereassociatedwith1)bothmotherand infant receiving prophylaxis, 2) children never breastfed and 3) mother being 30 years old or greater. Overall between September2007andJuly2010,12.2%ofPCRresultswereHIVpositive.BetweenSeptember2007andJanuary200