Levels of vaccination coverage among HIV-exposed children in China: a retrospective study.

BACKGROUND: Vaccination is crucial for human immunodeficiency virus (HIV)-exposed children because of their increased risk of morbidity and mortality from various vaccine-preventable diseases. However, studies have shown that they are at high risk of incomplete vaccination. Although China has developed prevention of mother-to-child transmission (PMTCT) of HIV programs substantially over the past decades, few studies have investigated the immunization levels of Chinese HIV-exposed children. Therefore, we aimed to evaluate vaccination coverage and its associated factors among HIV-exposed children in China during 2016‒2018. METHODS: We conducted a retrospective cohort review of all cases of Chinese HIV-exposed children born between July 1, 2016 and June 30, 2018 recorded in the Chinese information system on PMTCT. The vaccination coverage indicators refer to the percentage of children who received recommended basic vaccines, including Bacillus Calmette-Guérin (BCG), hepatitis B (HepB), polio, measles-containing vaccine (MCV), and diphtheria-tetanus-pertussis-containing (DTP) vaccine. Univariate and multivariate logistic regression analyses expressed as crude odds ratios (cORs) and adjusted odds ratios (aORs), each with 95% confidence intervals (95% CI), were performed to compare the proportional differences of factors associated with vaccine coverage. RESULTS: Among the enrolled 10 033 children, the vaccination rate was 54.1% for BCG, 84.5% for complete HepB vaccination, 54.5% for complete polio vaccination, 51.3% for MCV, and 59.5% for complete DTP vaccination. Children with perinatally acquired HIV (PHIV) were 2.46‒3.82 times less likely to be vaccinated than HIV-exposed uninfected children. Multivariate logistic regression indicated that children of Han ethnicity (aOR = 1.33‒2.04), children with early infant diagnosis (EID) of HIV (aOR = 1.86‒3.17), and children whose mothers had better education (college or above, aOR = 1.63‒2.51) had higher odds of being vaccinated. Most of the deceased children (aOR = 4.28‒21.55) missed vaccination, and PHIV (aOR = 2.46‒3.82) significantly affected immunization. CONCLUSIONS: Chinese HIV-exposed children had low vaccination coverage, which is a serious health challenge that needs to be addressed thoroughly. Interventions should be developed with a focus on minority HIV-exposed children whose mothers do not have formal education. Particularly, more attention should be paid to EID to increase access to immunization.

Outcomes of the national programme on prevention of mother-to-child transmission of hepatitis B virus in China, 2016-2017.

BACKGROUND: In addition to providing free hepatitis B vaccine (HBvacc) series to all infants in China since 2005, the national programme on prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) started providing free hepatitis B immunoglobulin for all new-borns born to hepatitis B surface-antigen (HBsAg) positive mothers in 2010. However, few studies have evaluated the effectiveness of the PMTCT programme. Therefore, we aimed to investigate the outcomes of the programme and identify associated factors. METHOD: Using a cross-sectional study design, we collected data on 4112 pairs of HBsAg-positive mothers and their children aged 7-22 months in four representative provinces through interviews and medical record review. We tested HBsAg and hepatitis B surface antibody (anti-HBs) of children by enzyme-linked immunosorbent assay at designated maternal and child hospital laboratories. We used logistic regression to analyse factors associated with child HBsAg and anti-HBs positivity. RESULTS: Thirty-five children were HBsAg positive, indicating the mother-to-child transmission (MTCT) rate was 0.9% (0.6-1.1%). The anti-HBs positive rate was 96.8% (96.3-97.4%). Children receiving HBvacc between 12 and 24 h of birth were 2.9 times more likely to be infected than those vaccinated in less than 12 h (adjusted odds ratio [aOR] = 2.9, 95% confidence interval [CI]: 1.4-6.3, P = 0.01). Maternal hepatitis B e-antigen (HBeAg) positivity was associated with higher MTCT rate (aOR = 79.1, 95% CI: 10.8-580.2, P <  0.001) and lower anti-HBs positive rate (aOR = 0.4, 95% CI: 0.3-0.6, P <  0.001). Children with low birth weight (LBW) were 60% less likely to be anti-HBs positive than those with normal birth weight (aOR = 0.4, 95% CI: 0.2-0.8, P = 0.01). CONCLUSIONS: The MTCT rate was lower than the 2030 WHO elimination goal, which implies the programme is on track to achieve this target. As earlier HBvacc birth dose (HBvcc-BD) was associated with lower MTCT rate, we suggest that the PMTCT programme work with the Expanded Programme on Immunization (EPI) to modify the current recommendation for early HBvcc-BD to a requirement. Our finding that LBW was associated with lower anti-HBs positivity points to the need for further studies to understand factors associated with these risks and opportunities for program strengthening. The programme needs to ensure providing essential test to identify HBeAg-positive mothers and their infants and provide them with appropriate medical care and follow-up.

Acceptability and feasibility of dual HIV and syphilis point-of-care testing for early detection of infection among pregnant women in China: a prospective study.

OBJECTIVE: To assess the feasibility and acceptability of using WHO prequalified combined dual HIV/syphilis rapid diagnostic tests (RDT) for same-day results in antenatal care (ANC) clinics. METHODS: This is a pragmatic implementation study using quantitative approach to evaluate outcomes. Antenatal clinic attendees from 21 rural and urban township hospitals in two provinces of China were offered with free dual RDTs testing that included HIV and syphilis, in addition to the routine blood tests. Study outcomes included testing uptake before and during dual RDT use, test feasibility and acceptability among pregnant women. Regression model was used to assess acceptance of RDT testing. RESULTS: In total, 1787 out of 1828 pregnant women attending ANC received the RDT testing. Testing uptake among pregnant women in their first and second trimester increased from 76.0% (2438/3269) using standard blood testing to 90.1% (1626/1787) with concurrent RDT use (χ2=197.1, p<0.001). Among 1787 pregnant women who received RDT tests, 98.3% (1757/1787) participants were given test result the same day. Positive proportions of HIV and syphilis screened with RDT were 0.06% (1/1787) and 1.0% (18/1787), respectively. Regression analysis indicated that women who did not receive syphilis or HIV testing before were less likely to accept dual RDT (OR 0.28, 95% CI 0.10 to 0.75). Acceptance for dual RDT testing at second or third antenatal visit was lower compared with the first visit (OR 0.37, 95% CI 0.15 to 0.94). CONCLUSION: Combined dual HIV/syphilis RDT with same-day results increased uptake of HIV and syphilis testing among pregnant women at primary healthcare facilities. Given the diversity of testing capacities among health services especially in rural areas in China, the dual RDT kit is feasible tool to improve testing uptake among pregnant women.

Integrated prevention of mother-to-child transmission for human immunodeficiency virus, syphilis and hepatitis B virus in China.

PROBLEM: China continues to face challenges in eliminating mother-to-child transmission of human immunodeficiency virus (HIV), syphilis and hepatitis B virus (HBV). APPROACH: In 2010, a programme that integrated and standardized prevention of mother-to-child transmission (PMTCT) efforts for HIV, syphilis and HBV was implemented in 1156 counties. At participating antenatal care clinics, pregnant women were offered all three tests concurrently and free of charge. Further interventions such as free treatment, prophylaxis and testing for mothers and their children were provided for HIV and syphilis. LOCAL SETTING: China's national PMTCT HIV programme started in 2003, at which time there were no national programmes for perinatal syphilis and HBV. In 2009, the rate of maternal-to-child transmission of HIV was 8.1% (57/702). Reported congenital syphilis was 60.8 per 100,000 live births. HBV infection was 7.2% of the overall population infected. RELEVANT CHANGES: Between 2010 and 2013 the number of pregnant women attending antenatal care clinics with integrated PMTCT services increased from 5.5 million to 13.1 million. In 2013, 12.7 million pregnant women were tested for HIV, 12.6 million for syphilis and 12.7 million for HBV. Mother-to-child transmission of HIV fell to 6.7% in 2013. Data on syphilis transmission are not yet available. LESSONS LEARNT: Integrated PMTCT services proved to be feasible and effective, and they are now part of the routine maternal and child health services provided to infected women. The services are provided through a collaboration between maternal and child health clinics, the national and local Centers for Disease Control and Prevention, and general hospitals.

[Analysis of partner attitude toward HIV infected pregnant women and its influencing factors in western China during 2005-2011].

OBJECTIVE: To analyze partner attitude change and influencing factors on HIV infected pregnant women HIV disclosure. METHOD: A multi-stage cross sectional method was used to collect information by questionnaires on 1164 HIV infected pregnant women in 6 counties including Ruili and Longchuan in Yunnan, Hezhou, Lingshan and Pingxiang in Guangxi and Yining in Xinjiang. Information on demographic characteristics and sexual behavior of the subjects and partner attitude toward HIV infected pregnant women were obtained. The influencing factors of partner's discrimination against HIV infected pregnant women were analyzed. RESULT: A total of 991(85.1%) HIV infected pregnant women have disclosed HIV status to partners among 1164 respondents and 39 (3.9%) reported they were discriminated against partners. Multivariate analysis showed that the 6.5% (15/231) of HIV infected pregnant women in urban had discrimination from their husbands while the ratio among rural pregnant women was lower(3.2% (24/760), OR = 0.40, 95%CI:0.12-0.77) . Compared with the ratio of discrimination among the women of first marriage(2.9%, 21/731), the discrimination ratio among women with remarriage and other status was higher (6.5% (15/232),OR = 2.45, 95%CI:1.61-5.25 and 10.7% (3/28),OR = 3.77, 95%CI:1.46-9.88) respectively. The discrimination ratio among pregnant women with multiple sexual partners was 5.9% (23/389), higher than women with single partner (2.6%, 15/580) (OR = 2.21, 95%CI:1.80-6.23). CONCLUSION: The discrimination toward HIV infected pregnant women from husbands was related to demographic characteristics and sexual behaviors.

[Analysis on the intervention services status of prevention of mother to child transmission of HIV/AIDS in China].

OBJECTIVE: The purpose of this study is to get to know the intervention services implementation status of prevention of mother to child transmission (PMTCT) of HIV/AIDS in China, and the trend of recent five years. METHODS: We carried out relevant surveys and investigations among the areas where PMTCT work had been implemented during January 2005 to December 2009. Health providers in these fields provided routine maternal health care, HIV counseling and test for 10 360 655 pregnant women and comprehensive intervention measures to 10 123 HIV infected pregnant women which included antiretroviral (ARV) drugs usage, safety delivery, and exclusive breastfeeding, and collected relevant data and materials to analysis the ratio of main interventions and its change trend. RESULTS: The HIV/AIDS counseling rate was increasing year by year (χ(2)(trend) = 3184.5, P < 0.001), during 2005 to 2009 the rate was 69.8% (406 151/581 975), 84.5% (1 346 745/1 594 579), 90.3% (1 582 757/1 753 191), 93.7% (1 926 224/2 055 232), 82.3% (3 599 228/4 375 678) respectively. HIV/AIDS test rate was increasing (χ(2)(trend) = 146 194.7, P < 0.001), the rate from 2005 to 2009 was 57.8% (336 459/581 975), 80.8% (1 287 812/1 594 579), 87.0% (1 524 595/1 753 191), 89.2% (1 833 246/2 055 232), 85.5% (3 741 337/4 375 678)respectively. The total number of HIV/AIDS infected maternities was 10 123 during 2005-2009, 6156 of them delivered, the general usage rate of ARVs was 71.0% (4373/6156), and increasing to 75.3% (1554/2065) by the end of 2009, the rates of 2005 to 2008 were 64.6% (362/560), 66.9% (623/931), 66.7% (857/1284), 74.2% (977/1316) respectively. The difference was significant (χ(2)(trend) = 47.6, P < 0.001). The proportion of using ARVs during pregnant period was 58.5% (2557/4373). The proportion of using ARVs among born infants of HIV infected maternities was 83.4% (4999/5994), and increasing yearly, 77.2% (409/530) of 2005, 80.1% (720/899) of 2006, 83.8% (1053/1257) of 2007, 89.4% (1116/1249) of 2008, 82.6% (1701/2059) of 2009, the difference was significant (χ(2)(trend) = 13.0, P < 0.001). The general rate of exclusive breastfeeding was 92.9% (5276/5681) and the rate of HIV test in 18 months was 74.6% (2482/3324). CONCLUSION: The rate of HIV/AIDS counseling and test of general maternities is increasing and the proportion of mainly intervention measures have been increased year by year.

[Efficacy analysis of different antiretroviral drug regimens in mother to child HIV transmission prevention in some regions of China].

OBJECTIVE: To determine the efficacy of different antiretroviral drug regimens in mother to child HIV transmission prevention (PMTCT) in China. METHODS: From January 1st 2006 to Dec 30th 2008, a total of 1072 pairs of HIV positive pregnant women and their babies who were HIV antibody positive and older than 18 months were recruited in this study. These women who had received maternal health care in health care institutions were from 23 provinces. Subjects were investigated by questionnaire, including social demographic data, usage of ARVs, safe delivery and artificial feeding, and other PMTCT related informations. The trend of different antiretroviral drug regiments in different period were analyzed by Cochran-Mantel-Haenszel (CMH) χ(2) test. By stratified analysis and Fisher exact χ(2) test, the efficacy of different antiretroviral drug regimens in mother to child HIV transmission prevention were studied. Antiretroviral drug regimens applications mainly included sd-NVP drug regimen, prophylaxis regimen and highly active anti-retroviral therapy (HAART). RESULTS: Among 1072 pairs of HIV positive maternities and babies, 31 babies older than 18 months were HIV infected, MTCT rate was 2.9% (31/1072). (1) The proportion of using ARVs was increasing from 76.4% (306/395) in 2006 to 83.8% (372/444) in 2008, the difference was significant (CMH χ(2) = 6.4, P < 0.05). (2) The ratio that HIV infected maternities adopted ARVs rose from 3.4% (6/178) in 2006 to 26.3% (104/395) in 2008, the ratio increased year by year (CMH χ(2) = 53.1, P < 0.01). On the contrary, usage of sd-NVP declined from 88.8% (158/178) in 2006 to 70.9% (264/372) in 2008 (CMH χ(2) = 48.5, P < 0.01). (3) Among maternities adopted vaginal delivery and artificial feeding, the MTCT rate of ARVs combination group was 1.0% (1/104), while the MTCT rate of sd-NVP group was 5.9% (16/272) (Fisher χ(2) = 5.5, P < 0.05). (4) In the case of artificial feeding, the MTCT rate of prophylaxis regimens and HAART among maternities adopted vaginal delivery was 3.1% (1/32) and 0 respectively. Among maternities adopted cesarean delivery, MTCT rate of prophylaxis regimens and HAART was 3.2% (2/63) and 3.1%(1/32) respectively, both showed no significant difference (Fisher χ(2) = 1.4, P > 0.05; Fisher χ(2) = 0.0001, P > 0.05). CONCLUSION: Effect of combination of antiretroviral drugs to PMTCT is obvious, the rate of mother to child HIV transmission of prophylaxis regimens and HAART has not shown significant difference.

[Impact of being informed of HIV sero-status on the utilization of mother-to-child HIV transmission prevention services before or after pregnancy].

OBJECTIVE: To explore the impact of being informed of HIV infection before or after pregnancy on the prevention of mother-to-child transmission (PMTCT) HIV interventions uptake. METHODS: From 2005 to 2009, a tatal of 5552 HIV-infected pregnant women and their 5894 pregnancies in Henan, Guangxi, Yunnan and Xinjiang province were investigated using the method of a cohort study. The social-demographic characters (the objects were divided three age groups 15-, 25-, 35-49), the period identified to be HIV positive, the outcome of pregnancy and the PMTCT interventions including uptake of antiretroviral drugs (ARVs) were investigated. Through single-factor and non-conditional logistic regression model, the factors influencing the utilization of PMTCT services were analyzed. RESULTS: Of HIV-infected pregnant women, 84.5% (4979/5894) were under 35 year-old, and 56.0% (3108/5552) of them were Han group and the percentage of peasant or unemployment was 85.1% (4727/5552). 86.8% (4815/5552) of these women had junior high school education or less, and the proportion of women knowing HIV infection before the pregnancy was 31.2% (1836/5894). Of HIV positive pregnant women, 31.7% (1869/5894) chose to terminate the pregnancy artificially, and the percentage was 43.8% (805/1836) among those knowing HIV infection before pregnancy. The proportion of the ARVs uptake among HIV positive maternities who delivered was 80.0% (3046/3808), while the percentage among those knowing HIV positive before pregnancy was 92.3% (883/957), which was much higher than it (75.9% (2163/2851)) among the pregnant women knowing HIV infection just during the pregnancy (χ(2) = 120.39, P < 0.05). The results of multivariate analysis showed that the proportion of ARVs' uptake was high among those HIV positive pregnant women knowing to be HIV-infected before pregnancy (versus knowing to be HIV-infected after the pregnancy, OR = 3.91 (95%CI: 3.03 - 5.05)) and age of 15 to 24 year-old (versus age of 35 - 49 year-old, OR = 0.75 (95%CI: 0.57 - 0.98)). CONCLUSION: It will promote the HIV-infected pregnant women to receive the PMTCT intervention services if they know their HIV sero-status before pregnancy.

[Cost-effectiveness analysis for integrated prevention of mother-to-child transmission of HIV].

OBJECTIVE: To evaluate the cost-effectiveness and economic efficiency of integrated prevention of mother-to-child transmission (PMTCT) of HIV in four high-incidence counties. METHODS: Data of local resource investment and total cost for PMTCT in 4 counties in China from 2003 to 2006 were collected. Cost analysis and cost-effectiveness analysis were conducted. Average costs of a confirmed HIV case, a prevented case and a disability-adjusted life-year (DALY) saving were calculated. RESULTS: Average cost of identifying one HIV-infected mother was yen5512. Costs of a pediatric HIV case prevention and per DALY saving were yen46 747 and yen1870 ($231), respectively, based on the total cost perspective. CONCLUSION: The cost of integrated prevention of mother-to-child transmission of HIV was low. The PMTCT program was economical efficiency.