广东地区预防HIV母婴传播服务需求与能力分析

汤柳英; 王雄虎; 马远珠; 高爽; 王智强; 李兵; 夏建红

doi:10.16462/j.cnki.zhjbkz.2019.12.015

广东地区预防HIV母婴传播服务需求与能力分析

doi: 10.16462/j.cnki.zhjbkz.2019.12.015

511442 广州, 广东省妇幼保健院保健部

基金项目:

国家科技重大专项 2015ZX10001001

详细信息

通讯作者:
夏建红, E-mail: xixixia58@126.com

中图分类号: R512.91
计量
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- 被引次数: 0
出版历程
- 收稿日期: 2019-02-21
- 修回日期: 2019-06-14
- 刊出日期: 2019-12-10

Service demand and capacity of HIV prevention of mother-to-child transmission in Guangdong

Heath Care Department of Guangdong Women and Children's Hospital, Guangzhou 511442, China

Funds:

National Science and Technology Major Project of China 2015ZX10001001

More Information

Corresponding author: XIA Jian-hong, E-mail: xixixia58@126.com

摘要

摘要: 目的分析广东省各地预防艾滋病母婴传播（mother-to-chlid transmission，MTCT）的服务需求与能力，了解工作的薄弱地区和环节。方法收集2014年-2017年广东省感染人类免疫缺陷病毒（human acquired immunodeficiency virus，HIV）的孕产妇及暴露婴儿的服务需求及干预情况，使用SPSS 21.0软件分析各地服务需求与能力差异，以及各地助产机构和母婴保健人员数量与HIV的MTCT之间相关性。结果感染HIV孕产妇文化程度不高，以初中为主（54.49%）；各地感染HIV的孕产妇服务需求不同，珠三角区外来少数民族（12.96%）、山区非本地居住（43.75%）、东翼感染途径不详（77.78%）孕产妇占比高；各地服务能力不同，山区和东翼孕产妇多产时/产后确诊（占比41.67%和44.44%）、治疗晚（山区和东翼超过36周治疗或未治疗占比43.75%和55.56%）、孕产妇和婴儿未治疗比例高（山区和东翼为2.08%和33.33%），且东翼母乳喂养比例高（11.11%）；东翼助产服务机构和母婴保健服务人员数量少，覆盖面小；各地助产机构和母婴保健人员数量与MTCT均无相关性（均有P>0.05）。结论山区和东翼是广东省预防HIV的MTCT工作薄弱地区，检测晚、干预不规范、信息质量低是薄弱环节。有针对地消除服务能力的地区差异，是实现广东省消除HIV的MTCT目标的关键。
- 人类免疫缺陷病毒 /
- 母婴传播 /
- 助产机构 /
- 服务需求 /
- 服务能力
Abstract: Objective To analyze the service demand and capacity for preventing mother-to-child transmission(MTCT) of acquired immune deficiency syndrome in Guangdong, as well as to find the weakness in the work. Methods The relevant data of service demands and intervention capacity of human acquired immunodeficiency virus(HIV)-infected maternal and their babies from 2014 to 2017 was collected, and SPSS 21.0 software was employed to analyze the differences among the pearl river delta area, western area, mountainous area and eastern area, and to explore the correlation between regional midwifery institutions or personnel numbers and the rate of HIV MTCT. Results The education of HIV-infected maternal wasn't high, generally, mainly in middle school (54.49%). The service demand of HIV-infected maternal was different in each area. The ethnic minorities outside the pearl river delta region (12.96%) and non-local living maternal in mountainous area (43.75%) were high. The proportion of maternal in the eastern area who didn't know the route of HIV infection was also high (77.78%). The service capacity varies in each area, and the proportion (mountainous area: 41.67%, eastern area: 44.44%) of the confirmation time in intrapartum/postpartum was high among those from the mountains and eastern areas, which lead to poor intervention (the proportions of starting to antiretroviral treatment time later than 36 weeks or untreated in mountainous and eastern areas were 43.75% and 55.56%, respectively), as well as a high proportion of untreated maternal and exposed-infant (mountainous area: 2.08%, eastern area: 33.33%), and a higher percentage (11.11%) of breastfeeding in eastern area. There was no significant correlation between the number of midwifery institutions or healthcare personnel and the rate of HIV MTCT in different regions. Conclusions The mountainous and eastern areas are the weak of HIV MTCT in Guangdong Province, and later detection, less-standard intervention, and lower quality of information management are the weak steps in those areas. Targeted measures should be urgently developed to strengthen the training of the key areas to eliminate the regional differences of service capacity, which is essential to achieve the elimination of HIV MTCT in Guangdong.
- HIV /
- Mother-to-child transmission /
- Midwifery institutions /
- Service demand /
- Service capacity

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图 1 广东省各地区助产服务机构和人员配置数量与HIV母婴传播情况分析

Figure 1. Analysis of regional midwifery institution and personnel allocation numbers with the rate of HIV MTCT in Guangdong Province

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表 1 广东省各地区感染HIV孕产妇和暴露婴儿的服务需求情况分析[n(%)]

Table 1. Analysis of service demand of HIV-infected maternal and exposed infants in Guangdong[n(%)]

特征变量	合计	分布地区				χ²/F值	P值
特征变量	合计	珠三角区(n=216)	西翼(n=72)	山区(n= 48)	东翼(n=9)	χ²/F值	P值
孕产妇
孕产妇年龄(岁，x±s)	29.32±5.55	29.28±5.69	29.54±5.33	29.88±5.48	25.44±3.13	1.67	0.173
年龄组(岁)						4.96	0.548
< 20	11	5(2.31)	4(5.56)	2(4.17)	0(0.00)
20~	269	169(78.24)	53(73.61)	38(79.17)	9(100.00)
≥35	65	42(19.44)	15(20.83)	8(16.67)	0(0.00)
民族						4.66	0.014
汉族	312	188(87.04)	71(98.61)	44(91.67)	9(100.00)
其他	33	28(12.96)	1(1.39)	4(8.33)	0(0.00)
本地居住						8.60	0.034
是	251	161(74.54)	56(76.39)	27(56.25)	8(88.89)
否	94	55(25.46)	17(23.61)	21(43.75)	1(11.11)
文化程度						18.89	0.090
小学及以下	43	26(12.04)	8(11.11)	7(14.58)	2(22.22)
初中	188	105(48.61)	45(62.50)	32(66.67)	6(66.67)
高中	67	49(22.69)	13(18.06)	5(10.42)	0(0.00)
大学及以上	31	27(12.50)	2(2.78)	2(4.17)	0(0.00)
不详	16	9(4.17)	4(5.56)	2(4.17)	1(11.11)
可能的感染途径						16.58	0.036
性传播	200	137(63.43)	40(55.56)	21(43.75)	2(22.22)
血液传播	11	7(3.24)	1(1.39)	3(6.25)	0(0.00)
母婴传播	2	1(0.46)	1(1.39)	0(0.00)	0(0.00)
不详/其他	132	71(32.87)	30(41.67)	24(50.00)	7(77.78)
职业						26.87	0.008
家庭主妇/无业	190	118(54.63)	38(52.78)	30(62.50)	4(44.44)
工人	37	26(12.04)	5(6.94)	5(10.42)	1(11.11)
农民	47	17(7.87)	20(27.78)	8(16.67)	2(22.22)
商业服务	20	16(7.41)	3(4.17)	1(2.08)	0(0.00)
其他	51	39(18.06)	6(8.33)	4(8.33)	2(22.22)
婚姻状况						4.67	0.867
初婚	237	145(67.13)	51(70.83)	34(70.83)	7(77.78)
再婚	53	31(14.35)	13(18.06)	8(16.67)	1(11.11)
未婚/同居	50	37(17.13)	7(9.72)	5(10.42)	1(11.11)
离婚/丧偶	5	3(1.39)	1(1.39)	1(2.08)	0(0.00)
孕次^a						15.69	0.011
1	80	55(25.82)	12(16.67)	7(14.58)	6(66.67)
2~	196	119(55.87)	48(66.67)	26(54.17)	3(33.33)
>3	66	39(18.31)	12(16.67)	15(31.25)	0(0.00)
产次						34.83	< 0.001
0	131	105(48.61)	14(19.44)	8(16.67)	4(44.44)
1~	188	101(46.76)	49(68.06)	33(68.75)	5(55.56)
>2	26	10(4.63)	9(12.50)	7(14.58)	0(0.00)
孕产期异常情况						1.66	0.642
无	269	171(79.17)	57(79.17)	34(70.83)	7(77.78)
有	76	45(20.83)	15(20.83)	14(29.17)	2(22.22)
分娩机构						15.95	0.033
地市级以上	183	126(58.33)	30(41.67)	25(52.08)	2(22.22)
县/区级	119	62(28.70)	33(45.83)	19(39.58)	5(55.56)
街道/乡镇级	37	25(11.57)	8(11.11)	2(4.17)	2(22.22)
其他(kg, x±s)	6	3(1.39)	1(1.39)	2(4.17)	0(0.00)
儿童
出生体重(kg, x±s)	2.97±0.49	3.02±0.49	2.88±0.52	2.93±0.43	2.86±0.42	1.83	0.142
出生身长(cm, x±s)	48.98±2.03	49.03±1.98	49.25±1.55	48.25±2.78	49.56±1.24	2.81	0.039
性别						7.09	0.068
男	179	115(53.24)	32(44.44)	30(62.50)	2(22.22)
女	166	101(46.76)	40(55.56)	18(37.50)	7(77.78)
早诊采血机构						54.39	< 0.001
地市级以上	167	115(53.24)	25(34.72)	27(56.25)	0(0.00)
县/区级	142	65(30.09)	47(65.28)	21(43.75)	9(100.00)
街道/乡镇级和其他	36	36(16.67)	0(0.00)	0(0.00)	0(0.00)
注：^a孕次信息缺失3人。

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表 2 广东省各地区预防HIV母婴传播工作服务能力分析[n(%)]

Table 2. Analysis of service capacity of PMTCT program in Guangdong[n(%)]

特征变量	合计	分布地区				χ²/t值	P值
特征变量	合计	珠三角区(n=216)	西翼(n=72)	山区(n= 48)	东翼(n=9)	χ²/t值	P值
机构分类						220.91	< 0.001
地市级以上	122	65(8.70)	19(5.21)	23(4.29)	15(5.49)
县/区级	329	146(19.54)	47(12.88)	84(15.67)	52(19.05)
街道/乡镇级	1 174	326(43.64)	260(71.23)	410(76.49)	178(65.20)
其他	296	210(28.11)	39(10.69)	19(3.55)	28(10.26)
检测
确认感染时期						24.81	< 0.001
孕前	103	71(32.87)	18(25.00)	13(27.08)	1(11.11)
孕期	172	117(54.17)	36(50.00)	15(31.25)	4(44.44)
产时/产后	70	28(12.96)	18(25.00)	20(41.67)	4(44.44)
性伴感染状态						7.50	0.251
阴性	127	89(41.20)	18(25.00)	18(37.50)	2(22.22)
阳性	82	49(22.69)	19(26.39)	12(25.00)	2(22.22)
不详	136	78(36.11)	35(48.61)	18(37.50)	5(55.56)
治疗
孕产妇抗病毒治疗						22.64	< 0.001
否	46	18(8.33)	10(13.89)	14(29.17)	4(44.44)
是	299	198(91.67)	62(86.11)	34(70.83)	5(55.56)
孕产妇抗病毒治疗时期(周)						28.76	< 0.001
< 13	116	81(37.50)	26(36.11)	8(16.67)	1(11.11)
13~	122	84(38.89)	20(27.78)	17(35.42)	1(11.11)
28~	18	10(4.63)	4(5.56)	2(4.17)	2(22.22)
≥36或未治疗	89	41(18.98)	22(30.56)	21(43.75)	5(55.56)
婴儿抗病毒治疗						21.87	< 0.001
否	7	1(0.46)	0(0.00)	3(6.25)	3(33.33)
是	338	215(99.54)	72(100.00)	45(93.75)	6(66.67)
母子抗病毒治疗						36.16	< 0.001
均治疗	297	198(91.67)	66(86.11)	32(66.67)	5(55.56)
仅一方治疗	43	17(7.87)	10(13.89)	15(31.25)	1(11.11)
均未治疗	5	1(0.46)	0(0.00)	1(2.08)	3(33.33)
安全助产和喂养
分娩方式						30.06	< 0.001
阴道产	176	87(40.28)	50(69.44)	30(62.50)	9(100.00)
择期剖宫产	101	77(35.65)	12(16.67)	12(25.00)	0(0.00)
急诊剖宫产	68	52(24.07)	10(13.89)	6(12.50)	0(0.00)
是否产科操作						8.25	0.040
否	293	190(87.96)	55(76.39)	42(87.50)	6(66.67)
是	52	26(12.04)	17(23.61)	6(12.50)	3(33.33)
喂养方式						31.54	< 0.001
母乳喂养	4	2(0.93)	0(0.00)	1(2.08)	1(11.11)
人工喂养	261	179(82.87)	41(56.94)	34(70.83)	7(77.78)
不详	80	35(16.20)	31(43.06)	13(27.08)	1(11.11)

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