了解肯尼亚接受艾滋病毒护理的母亲中的艾滋病毒母婴传播情况:个案报告。

IF 2.9 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Emily L Tuthill, Belinda C Odhiambo, Ann E Maltby
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引用次数: 0

摘要

背景:艾滋病毒的母婴传播可能发生在子宫内、分娩过程中或通过母乳,随着对妇女及其婴儿进行艾滋病毒检测和治疗的进步,目前这种传播在很大程度上是可以预防的。在全球范围内,多年来取得了巨大进步,从 2010 年到 2022 年,新增儿童感染率下降了 58%。目前,尽管肯尼亚一直在努力推广预防母婴传播战略,但该国仍是艾滋病毒母婴传播率最高的国家之一:本病例报告介绍了一位在肯尼亚从事艾滋病护理工作的妇女的经历,她的孩子感染了艾滋病毒。用于描述该案例的数据来自调查、提供者记录、健康记录、观察记录、电话咨询记录以及一次深入访谈。我们对所有数据来源进行了仔细审查、比较和整理,以描述事件发生的时间线和参与者的经历背景:我们发现有多种因素可能导致了这起母婴传播艾滋病的病例。产前护理在怀孕后期才开始(怀孕三个月时),因此,艾滋病毒的诊断和治疗也在怀孕后期才开始。此外,提供产前护理和艾滋病毒治疗的诊所与提供分娩服务的医院之间缺乏协调,导致在婴儿接受艾滋病毒预防药物治疗之前就开始母乳喂养。最后,孕产妇对艾滋病药物治疗的依从性较差,直到开始接受艾滋病治疗三个月后(产后两个多月)进行常规病毒载量监测时才被发现并得到解决:我们的病例报告表明,仍有必要为感染艾滋病毒的母亲及其婴儿提供更密集的综合护理,包括为新诊断出感染艾滋病毒的孕妇提供支持、协调围产期护理和艾滋病毒护理、对艾滋病毒药物依从性进行常规监测、密集的后续护理(包括对暴露于艾滋病毒的婴儿进行护理点检测)以及亲自提供母乳喂养支持。我们的病例报告提供了一个重要的视角,特别是考虑到联合国艾滋病规划署当前的全球艾滋病战略,该战略最近激发了全球消除儿童艾滋病联盟。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Understanding mother-to-child transmission of HIV among mothers engaged in HIV care in Kenya: a case report.

Background: Mother-to-child transmission of HIV, which may occur in utero, during birth, or through breastmilk, is now largely preventable with the advancement of HIV testing and treatment for women and their infants. Globally, great progress has been recorded over the years, with a 58% decline in new infections in children from 2010 to 2022. Currently, Kenya is among the countries with the highest rates of mother-to-child transmission of HIV despite consistent efforts to promote prevention of mother to child transmission strategies.

Methods: This case report presents the experiences of a woman, engaged in HIV care in Kenya, whose baby contracted HIV. The data used to describe this case come from surveys, provider notes, health records, observational notes, notes from phone call consultations, and one in-depth interview. All data sources were carefully reviewed, compared and complied to describe the timeline of events and context of the participant's experience.

Results: We found multiple factors which may have contributed to this case of mother-to-child transmission of HIV. Antenatal care was initiated late in pregnancy (during the third trimester), and as a result, HIV diagnosis and treatment also occurred late in pregnancy. In addition, a lack of coordination between the clinic providing antenatal care and HIV treatment, and the hospital providing labor and delivery services led to breastfeeding initiation prior to the administration of infant HIV prophylaxis medications. Finally, poor maternal adherence to HIV medications went undetected and unaddressed until it was revealed by routine viral load monitoring three months after initiating HIV treatment (more than two months postpartum).

Conclusions: Our case report shows the continued need for more intensive and integrated care for mothers living with HIV and their infants including support for pregnant women newly diagnosed with HIV, coordination of perinatal and HIV care, provisions for routine monitoring of HIV medication adherence, intensive follow-up care including point of care testing for HIV exposed infants and in person breastfeeding support. Our case report contributes an important perspective especially in light of the current UNAIDS Global AIDS Strategy which recently inspired the Global Alliance to end AIDS in Children.

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来源期刊
International Breastfeeding Journal
International Breastfeeding Journal Medicine-Obstetrics and Gynecology
CiteScore
6.30
自引率
11.40%
发文量
76
审稿时长
32 weeks
期刊介绍: Breastfeeding is recognized as an important public health issue with enormous social and economic implications. Infants who do not receive breast milk are likely to experience poorer health outcomes than breastfed infants; mothers who do not breastfeed increase their own health risks. Publications on the topic of breastfeeding are wide ranging. Articles about breastfeeding are currently published journals focused on nursing, midwifery, paediatric, obstetric, family medicine, public health, immunology, physiology, sociology and many other topics. In addition, electronic publishing allows fast publication time for authors and Open Access ensures the journal is easily accessible to readers.
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