Background

In Malawi’s PMTCT Option B+ program, HIV-infected pregnant women who are already receiving ART are continued on their current therapy regimen without testing for treatment failure at the first antenatal care (ANC) visit. HIV RNA screening at ANC may identify women with treatment failure and ensure that viral suppression is maintained throughout the pregnancy.

Methods

We conducted a cross-sectional study of HIV-infected pregnant women who had been receiving ART for at least 6 months at the first ANC visit under the PMTCT Option B+ program at Bwaila Hospital in Lilongwe, Malawi from June 2015 to December 2017. Poisson regression models with robust variance were used to investigate the predictors of ART treatment failure defined as viral load ≥1000 copies/ml.

Results

The median age of 864 women tested for ART failure was 31.1 years (interquartile range: 26.9–34.5). The prevalence of treatment failure was 7.6% (95% confidence interval (CI): 6.0–9.6). CD4 cell count (adjusted prevalence ratio (aPR) = 0.57; 95% CI: 0.50–0.65) was strongly associated with treatment failure.

Conclusion

The low prevalence of treatment failure among women presenting for their first ANC in urban Malawi demonstrates success of Option B+ in maintaining viral suppression and suggests progress towards the last 90% of the UNAIDS 90-90-90 targets. Women failing on ART should be identified early for adherence counseling and may require switching to an alternative ART regimen.

中文翻译：

---

感染艾滋病毒的孕妇在第一次产前护理中抗逆转录病毒治疗失败的发生率：马拉维 PMTCT 选项 B+

背景

在马拉维的 PMTCT 选项 B+ 计划中，已经接受 ART 的 HIV 感染孕妇将继续接受当前的治疗方案，而无需在第一次产前护理 (ANC) 就诊时检测治疗失败情况。ANC 的 HIV RNA 筛查可以识别治疗失败的女性，并确保在整个怀孕期间维持病毒抑制。

方法

我们对感染 HIV 的孕妇进行了一项横断面研究，这些孕妇于 2015 年 6 月至 2017 年 12 月在马拉维利隆圭 Bwaila 医院的 PMTCT 选项 B+ 项目下首次 ANC 就诊时接受了 ART 至少 6 个月。 泊松回归使用具有稳健方差的模型来研究 ART 治疗失败的预测因子，定义为病毒载量≥1000 拷贝/ml。

结果

接受 ART 失败测试的 864 名女性的中位年龄为 31.1 岁（四分位数范围：26.9-34.5）。治疗失败率为 7.6%（95% 置信区间 (CI)：6.0–9.6）。CD4 细胞计数（调整后患病率 (aPR) = 0.57；95% CI：0.50–0.65）与治疗失败密切相关。

结论

在马拉维城市首次接受 ANC 的妇女中，治疗失败率较低，这表明方案 B+ 在维持病毒抑制方面取得了成功，并表明在实现 UNAIDS 90-90-90 目标的最后 90% 方面取得了进展。应及早发现接受 ART 治疗失败的女性，进行依从性咨询，并可能需要改用替代 ART 治疗方案。