背景:艾滋病毒的母婴传播,可能发生在子宫内,出生时,或者通过母乳,随着对妇女及其婴儿的艾滋病毒检测和治疗的推进,现在在很大程度上是可以预防的。全球范围内,多年来取得了巨大的进步,从2010年到2022年,儿童新感染人数下降了58%。目前,肯尼亚是艾滋病毒母婴传播率最高的国家之一,尽管一直在努力促进预防母婴传播战略。
方法:本案例报告介绍了一名女性的经历,在肯尼亚从事艾滋病毒护理,他的孩子感染了艾滋病毒。用来描述这种情况的数据来自调查,提供者注释,健康记录,观测笔记,电话咨询的笔记,还有一次深度采访.所有数据来源都经过仔细审查,比较并遵守描述事件的时间表和参与者体验的背景。
结果:我们发现了多种因素,这些因素可能是导致这种母婴传播艾滋病毒的原因。产前护理在妊娠晚期(妊娠晚期)开始,结果,HIV诊断和治疗也发生在妊娠晚期。此外,提供产前护理和艾滋病毒治疗的诊所之间缺乏协调,和提供劳动和分娩服务的医院导致在施用婴儿艾滋病毒预防药物之前开始母乳喂养。最后,在开始HIV治疗3个月(产后2个月以上)后,通过常规病毒载量监测发现孕妇对HIV药物治疗的依从性差,但未被发现和解决.
结论:我们的病例报告显示,继续需要为感染艾滋病毒的母亲及其婴儿提供更深入和综合的护理,包括为新诊断为艾滋病毒的孕妇提供支持。围产期和艾滋病毒护理的协调,对艾滋病毒药物依从性进行常规监测的规定,强化后续护理,包括对暴露于艾滋病毒的婴儿进行点护理检测和亲自母乳喂养支持。我们的案例报告提供了一个重要的观点,特别是鉴于当前的UNAIDS全球艾滋病战略,该战略最近激励全球联盟结束儿童艾滋病。
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.