Analysis On The Status And Trend Of Preventing Mother-to-child Transmission Of Hiv,Syphilis And Hepatitis B In Chengguan District Of Lanzhou City

ObjectiveThis study intends to evaluate the current situation and the effect of prevention mother-to-child transmission（PMTCT）of“HIV,syphilis and hepatitis B”in Chengguan District,and to provide a basis for better development of PMTCT work in the future.Methods1.The data was collected about HIV consultation and detection of pre-marital examinations,pregnant women receiving initial antenatal care,and parturients,as well as basic information on HIV-positive gestation women and the information on the use of PMTCT measures of HIV-positive parturients and their babies in Chengguan District from 2009 to 2020.The consultation rate,detection rate,and treatment rate were described,as well as trend was analyzed by trend chi-square.Infants’birth weight and birth length of HIV-positive parturients were analyzed by single sample t test.Besides,epidemiology characteristic of HIV-positive gestation women was described.2.The data was collected about syphilis detection of pregnant women receiving initial antenatal care and parturients,as well as basic information on syphilis-positive gestation women,and the information on the use of PMTCT measures of syphilis-positive parturients and their babies in Chengguan District from July 1,2011to December 31,2020.The detection rate and treatment rate were described,as well as trend was analyzed by trend chi-square.Influence factors of the use of medication were analyzed in syphilis-positive parturients.Infants’birth weight and birth length of syphilis-positive parturients were analyzed by single sample t test,and the independent sample t test was used to analyze the differences between the birth weight and birth length of infants born to syphilis positive parturients and HIV positive parturients.Besides,basic situation was described in syphilis-positive gestation women,and incidence of congenital syphilis was calculated.3.The data was collected about hepatitis B detction of pregnant women receiving initial antenatal care and parturients,and the information on the use of PMTCT measures in Chengguan District from July 1,2011 to December 31,2020.The detection rate and the Hepatitis B Immunoglobulin（HBIG）injection rate were described,and the trend of detection rate was analyzed by trend chi-square.Results1.Analysis on the status and trend of PMTCT of HIV in Chengguan District of Lanzhou during 2009-2020（1）The detection and positive situation of HIV:（1）There were 165,008 pregnant women receiving initial antenatal care,whose detection rate was 94.63%.And the detection rate showed upward trend(?~2_trend=3217.561,P<0.001).The positive rate of detection was 1.02 per 10,000,showing upward trend(?~2_trend=17.608,P<0.001).（2）There were 166,683 parturients,whose detection rate was 96.68%.And the detection rate showed upward trend(?~2_trend=3924.103,P<0.001).The positive rate of detection was 0.81 per 10,000,showing upward trend(?~2_trend=4.886,P=0.027).（3）The parturients’detection rate during pregnancy was 92.18%.And the detection rate showed upward trend(?~2_trend=2722.946,P<0.001).（2）Basic situation of HIV-positive gestation women:（1）There were 28 gestation women of HIV-positive,and most of them were junior high or high school education,and farmers or unemployed women.（2）HIV-positive gestation women with known infection routes were infected by sexually transmitted.（3）Utilization of PMTCT measures in HIV-positive parturients:（1）There were 13HIV-positive parturients,of which 12 gave birth and 9（75%）were vaginal delivery,3（25%）were cesarean section.（2）Drug treatment rates of parturients and child were53.85%and 75.00%,respectively.（3）Five children（83.33%）were followed up,and the artificial feeding rate was 100%.（4）Intrauterine growth and development of infants delivered by HIV-positive parturients:The birth weight of male infants（2.61±0.68）kg was lower than the reference standard（t=-2.959,P=0.021）,and the birth length（47.63±3.25）cm was lower than the reference standard（t=-2.416,P=0.046）.（5）Effect of PMTCT of HIV:No children was found to be infected with HIV.2.Analysis on the status and trend of PMTCT of syphilis in Chengguan District of Lanzhou from 2011 to 2020（1）The detection and positive situation of syphilis:（1）There were 138,834pregnant women receiving initial antenatal care,whose detection rate was 94.90%,showing upward trend(?~2_trend=3470.992,P<0.001).Positive rate of detection was0.74‰,showing upward trend(?~2_trend=29.321,P<0.001).（2）There were 140,301parturients,whose detection rate was 98.80%,showing upward trend(?~2_trend=2761.176,P<0.001).Positive rate of detection was 0.7‰,showing upward trend(?~2_trend=26.970,P<0.001).（3）The parturients’detection rate during pregnancy was93.84%,showing upward trend(?~2_trend=1397.528,P<0.001).The positive rate during delivery test（4.74‰）was higher than pregnancy test（0.49‰）（?~2=171.186,P<0.001）.（2）Basic information of syphilis-positive gestation women:There were 173syphilis-positive gestation women,most of them were low level of education,and farmers or unemployed women.The staging of syphilis was mostly recessive.（3）Utilization of PMTCT measures in syphilis-positive parturients:（1）There were 97 syphilis-positive parturients,95 of which gave birth,and a total of 96 infants.Adverse pregnancy outcomes were mainly premature delivery or low birth weight,with 21（21.88%）occurring.（2）The drug application rate was 55.67%in parturients,showing upward trend(?~2_trend=15.420,P<0.001),and the standard medication rate for the treatment of parturients was 25.93%.（3）The rates of children preventive and therapeutic drug use were 52.75%and 66.67%,respectively,and the rate of preventive drug use showed upward trend(?~2_trend=16.154,P<0.001).（4）Influencing factors of medication for syphilis-positive parturients:Age>30years old was a risk factor for untreated,OR=3.699（1.531～8.935）,P=0.004;diagnosis during or after delivery was a risk factor for untreated,OR=3.393（1.334～8.632）,P=0.010.（5）Intrauterine growth and development of infants delivered by syphilis-positive parturients:（1）The birth length of male infants（49.36±2.70）cm was lower than the reference standard（t=-2.638,P=0.011）.（2）The birth weight of the female infants（3.03±0.53）kg and the birth length（48.89±2.56）cm were lower than the reference standard(t_weight=-2.345,P=0.023;t_length=-2.216,P=0.031).（3）The birth weight of male infants delivered by syphilis-positive parturients was higher than that of HIV-infected parturients（t=-2.814,P=0.007）.（6）Effect of PMTCT of syphilis:A total of 128,838 live births were delivered and 6 children with congenital syphilis from July 1,2011 to December 31,2019.The incidence of congenital syphilis was 4.66 per 100,000.3.Analysis on the status and trend of PMTCT of hepatitis B in Chengguan District of Lanzhou from 2011 to 2020（1）The detection and positive situation of hepatitis B:（1）There were 138,834pregnant women receiving initial antenatal care,whose detection rate was 95.97%.And the detection rate showed upward trend(?~2_trend=2788.273,P<0.001).Positive rate of detection was 2.25%.（2）There were 140,301 parturients,whose detection rate was98.95%,showing upward trend(?~2_trend=2027.913,P<0.001).Positive rate of detection was 3%.（3）Parturients’detection rate during pregnancy was 94.71%,showing upward trend(?~2_trend=726.362,P<0.001).The positive rate during delivery test（14.01%）was higher than that during pregnancy test（2.51%）（?~2=2587.786,P<0.001）.（2）Utilization of hepatitis B PMTCT measures:The cumulative number of hepatitis B positive parturients gave birth to 4187 live births,whose injection rate of HBIG was 99.79%.Conclusions1.The detection rate of“HIV,syphilis and hepatitis B”are on the rise in parturients and maternal pregnancy in Chengguan District,which have reached a higher level at present.Some progress has been made in PMTCT of HIV and syphilis,but the application level of blocking drugs for syphilis positive parturients and their children needs to be improved.2.Age and timing of diagnosis are factors that affect the medication of syphilis-positive parturients.Age>30 years old and diagnosis during or after delivery are risk factors for no medication.3.A female infected with HIV or syphilis may affect the growth and development of the fetus in the uterus.