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Field effectiveness of combination antiretroviral prophylaxis for the prevention of mother-to-child HIV transmission in rural Zambia

机译：联合抗逆转录病毒预防剂在赞比亚农村地区预防母婴艾滋病毒传播的现场效果

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Objective: To evaluate the effectiveness of maternal combination antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV (PMTCT) in a program setting.Design: Prospective cohort study.Setting: Nine primary care clinics in rural Zambia.Participants: Two hundred and eighty-four HIV-infected pregnant women at at least 28 weeks gestation initiating PMTCT services between April 2009 and January 2011 and their newborn infants.Intervention: In four 'intervention' sites, PMTCT comprised universal combination antiretroviral prophylaxis (i.e. irrespective of CD4 cell count) from pregnancy until the cessation of breastfeeding. In five 'control' sites, women received antenatal zidovudine and peripartum nevirapine, the standard of care at the time. Prophylaxis during breastfeeding was not available in control sites.Main outcome measure: Cumulative infant HIV infection and death at 12 months postpartum.Results: At 12 month postpartum, one of 104 (1.0%) infants born to mothers at the intervention sites were HIV-infected, compared with 14 of 116 (12.1%) receiving care in the control sites [relative risk (RR): 12.6, 95% Cl: 2.2-73.1; P = 0.005]. When we considered the composite outcome of HIV infection or death, similar trends were observed in the overall study population (RR: 3.4, 95% Cl: 1.6-7.6; P= 0.002) and in a sub-analysis of women with CD4 cell count more than 350 cells/mul (RR: 3.2; 95% Cl: 1.1-9.6; P = 0.04).Conclusion: When compared with PMTCT services based on antenatal zidovudine and peripartum nevirapine, the provision of maternal combination prophylaxis imparted measurable health benefits to HIV-exposed infants. Implementation research is needed to further tailor and optimize these strategies for similar field settings.
机译：目的：在一个项目环境中评估母体联合抗逆转录病毒疗法预防母婴传播艾滋病毒（PMTCT）的效果设计：前瞻性队列研究环境：赞比亚农村地区的九家初级保健诊所参与者：两百在2009年4月至2011年1月期间，至少有28名受HIV感染的孕妇至少在妊娠28周后开始PMTCT服务。他们的干预措施：在四个“干预”部位，PMTCT包括通用的联合抗逆转录病毒药物预防（即与CD4细胞无关）从怀孕到停止母乳喂养为止。在五个“对照”地点，妇女接受了产前齐多夫定和围产期奈韦拉平治疗，这是当时的护理标准。主要对照指标：产后12个月婴儿的HIV累积感染和死亡。结果：在产后12个月，干预部位母亲所生的104例婴儿（1.0％）中有1例是HIV-相比之下，在对照组接受治疗的116人中有14人（12.1％）[相对风险（RR）：12.6，95％Cl：2.2-73.1; P = 0.005]。当我们考虑HIV感染或死亡的综合结果时，在整个研究人群中观察到了类似的趋势（RR：3.4，95％Cl：1.6-7.6; P = 0.002）以及对具有CD4细胞计数的女性进行的亚分析超过350个细胞/ mul（RR：3.2; 95％Cl：1.1-9.6; P = 0.04）。结论：与基于产前齐多夫定和围产期奈韦拉平的PMTCT服务相比，提供孕产妇联合预防措施可为患者带来可衡量的健康益处感染艾滋病毒的婴儿。需要进行实施研究，以针对类似的现场设置进一步定制和优化这些策略。

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