Pregnant Womens Access to PMTCT and ART Services in South Africa and Implications for Universal Antiretroviral Treatment 英文参考文献.docVIP

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Pregnant Womens Access to PMTCT and ART Services in South Africa and Implications for Universal Antiretroviral Treatment 英文参考文献.doc

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Pregnant Womens Access to PMTCT and ART Services in South Africa and Implications for Universal Antiretroviral Treatment 英文参考文献

PregnantWomen’sAccesstoPMTCTandARTServicesin SouthAfricaandImplicationsforUniversalAntiretroviral Treatment AktharHussain1*,DhayendreMoodley2,SudhindraNaidoo2,TonyaM.Esterhuizen3 1DepartmentofFamilyMedicine,NelsonRMandelaSchoolofMedicine,UniversityofKwaZuluNatal,Durban,KwaZuluNatal,SouthAfrica,2Women’sHealthandHIV Research Unit, Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, KwaZulu Natal, South Africa, 3ProgrammeofBiostatistics,DepartmentofResearchEthicsandMedicalLaw,CollegeofHealthSciences,UniversityofKwaZuluNatal,Durban,KwaZuluNatal,South Africa Abstract Objectives:Wedescribepregnantwomens’accesstoPMTCTandHAARTservicesandassociatedbirthoutcomesinSouth Africa. Methods:WomenrecuperatinginpostnatalwardsofareferralhospitalparticipatedinanevaluationduringFebruary–May 2010duringwhichtheirmaternityrecordswereexaminedtodescribetheiraccesstoVCT,CD4Counts,dualARTorHAART duringpregnancy. Results:Ofthe1609womenwhoparticipatedinthisevaluation,39%(95%CI36.7–41.5%)testedHIV-positiveduringtheir pregnancy.OftheHIV-positivewomen2.9%didnothaveaCD4countdoneandanadditional31.3%didnotreceivetheir CD4results.Themajority(96.8%)oftheHIV-positivewomencommenceddualARTattheirfirstantenatalvisitindependent of their CD4 result. During February–May 2010, 48.0% of the women who had a CD4 result were eligible for HAART (CD4,200 cells/mm3) and 29.1% of these initiated HAART during pregnancy. Under the current South African PMTCT guidelines71.1%(95%CI66.4–75.4%)ofHIVpositivepregnantwomencouldbeeligibleforHAART(CD4,350cells/mm3). ThereweresignificantlymorepretermbirthsamongHIV-positivewomen(p=0.01)andwomenwhoreceivedHAARTwere nomoreatriskofpretermdeliveries(AOR0.73;95%CI0.39–1.36;p=0.2)ascomparedtowomenwhoreceiveddualART.Nine (2.4%;95%CI1.1–4.5%)HIVexposedinfantswereconfirmedHIVinfectedatbirth.Thein-uterotransmissionratewashighest amongwomenwhorequiredHAARTbutdidnotinitiatetreatment(8.5%)comparedto2.7%and0.4%amongwomenwho receiv