Progress Toward the Elimination of Vertical HIV Transmission in Nepal: A Retrospective Cohort Study.

IF 3.9 3区 医学 Q1 HEALTH POLICY & SERVICES
Upendra Shrestha, Lok Raj Pandey, Man Bahadur Kc, Ali Mirzazadeh, Keshab Deuba
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Abstract

Despite global advancements, pregnant women living with HIV in Nepal remain at risk for vertical transmission. This study examined demographic and clinical characteristics, antiretroviral therapy (ART) retention, and transmission outcomes among this population. A retrospective cohort analysis was conducted using data from Nepal's national electronic HIV register, including 322 women who became pregnant between 2020 and 2023. We analyzed sociodemographic profiles, clinical status at diagnosis, ART initiation timing, retention rates at 6, 12, and 24 months, and infant HIV status. The mean age was 26.9 years; over half (56.2%) were aged 25-39 years. Nearly 40% were illiterate, 87.6% unemployed, and 66.8% reported unsafe sexual behavior as the mode of HIV transmission. Over half (58.1%) were diagnosed prior to pregnancy, and 75.5% were in WHO Stage 1. ART began on the same day in 34.8% and within a week in 40.1%, with 56.8% already on ART during pregnancy. Retention was high: 96.9% at 6 months, 94.8% at 12 months, and 96.0% at 24 months. Vertical transmission occurred in 4.3% of pregnancies. Higher transmission rates were observed among younger mothers (6.9%), Dalit women (11.5%), those in advanced HIV stages (11.1%), with delayed ART initiation (8.6%), high viral loads (13.3%), and home deliveries (17.6%). In Nepal, approximately 1 in 23 infants born to women living with HIV still acquire the infection. Strengthening early diagnosis, improving ART uptake, and addressing disparities in care especially among high-risk groups are essential to eliminating vertical transmission and improving maternal and child health outcomes.

尼泊尔消除艾滋病毒垂直传播的进展:一项回顾性队列研究。
尽管全球取得了进展,但尼泊尔感染艾滋病毒的孕妇仍然面临垂直传播的风险。这项研究调查了人口统计学和临床特征,抗逆转录病毒治疗(ART)的保留和传播结果。利用尼泊尔国家电子艾滋病毒登记处的数据进行了回顾性队列分析,其中包括2020年至2023年间怀孕的322名妇女。我们分析了社会人口学概况、诊断时的临床状况、开始抗逆转录病毒治疗的时间、6个月、12个月和24个月的保留率以及婴儿艾滋病毒状况。平均年龄26.9岁;超过一半(56.2%)的患者年龄在25-39岁之间。近40%的人是文盲,87.6%的人没有工作,66.8%的人报告不安全的性行为是艾滋病毒的传播方式。超过一半(58.1%)在怀孕前被诊断出来,75.5%处于世卫组织第一阶段。34.8%的人在同一天开始接受抗逆转录病毒治疗,40.1%的人在一周内开始接受抗逆转录病毒治疗,56.8%的人在怀孕期间已经接受了抗逆转录病毒治疗。留存率很高:6个月时为96.9%,12个月时为94.8%,24个月时为96.0%。垂直传播发生率为4.3%。在年轻母亲(6.9%)、达利特妇女(11.5%)、艾滋病毒晚期(11.1%)、延迟开始抗逆转录病毒治疗(8.6%)、高病毒载量(13.3%)和在家分娩(17.6%)中观察到较高的传播率。在尼泊尔,大约每23名携带艾滋病毒的妇女所生的婴儿中就有1名仍然感染艾滋病毒。加强早期诊断,改善抗逆转录病毒治疗,解决特别是高危人群在护理方面的差异,对于消除垂直传播和改善孕产妇和儿童健康结果至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
10.80
自引率
1.70%
发文量
113
期刊介绍: The Journal of Community Health is a peer-reviewed publication that offers original articles on research, teaching, and the practice of community health and public health. Coverage includes public health, epidemiology, preventive medicine, health promotion, disease prevention, environmental and occupational health, health policy and management, and health disparities. The Journal does not publish articles on clinical medicine. Serving as a forum for the exchange of ideas, the Journal features articles on research that serve the educational needs of public and community health personnel.
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