背景：史瓦帝尼的愛滋病毒(HIV) 感染率為全世界最高，約有 27%人口為HIV感染者，其中有近一萬感染者為 0-14 歲的兒童。因此，如何避免母嬰傳播 (PMTCT)愛滋病毒，是史瓦帝尼醫療照護首要之方向，目前大約有 86% 的孕婦和哺乳期婦女正在接受抗逆轉錄病毒治療 (ART)，然而母嬰傳播 (MTCT) 率在產後18 個月時仍高達 8%。
目的：旨在評估感染 HIV母親與其嬰兒在懷孕前、懷孕期間、分娩和哺乳期間的 PMTCT 狀況。
方法：2021 年 7 月至 2021 年 12 月，在 Lobamba 診所和 RFM 醫院對參加 PMTCT 計劃並在史瓦帝尼接受產後護理的 101 對母嬰進行了橫斷面研究。利用自行開發的問卷，從母嬰保健卡中收集相關孕前、孕中與產後母嬰特徵與HIV相關照護資料，後使用頻率和百分比等方式來描述與分析資料。
結果：在101位暴露於HIV感染母親之嬰兒，其中有兩名嬰兒在出生後 6 週檢測出 HIV 陽性，其餘為陰性。在回顧資料中發現，我們發現HIV感染母親及其嬰兒在實際照護面上，與愛滋病毒預防母嬰傳播建議照護原則間存在差距，包括HIV感染女性的意外懷孕、產前檢查的參與未達預期、ART遵從性、妊娠期 HIV 診斷延遲、未接受藥物遵從性諮詢(SUAC)、延遲重啟 ART、混合餵養和延遲嬰兒 HIV 檢測等。

結論：為了縮小 PMTCT 護理中已確定的差距，必須對女性進行教育，使其了解維持抑制的病毒載量以降低 HIV 母嬰傳播風險的重要性。每個孕婦都必須獲得政府的財政支持，家庭參與孕產婦保健服務，引入家庭護理服務以及在 ANC 和 產後護理(PNC) 期間，由訓練有素的 社區衛生保健工作者(CHCWs) 定期家訪有助於提高衛生服務的利用率。
關鍵詞：愛滋病毒暴露、母嬰傳播、母嬰傳播、母乳喂養、預防方式、社區衛生保健工作者 。

Background: Eswatini has the highest prevalence of HIV with a rate of approximately 27%, of which 11,000 are children aged between 0-14 and 76% of them on antiretroviral treatment, as reported in 2018. Prevention of mother to child transmission (PMTCT) of HIV is a priority in Eswatini with approximately 86% of pregnant and breastfeeding women are on antiretroviral treatment (ART). Regardless of the high coverage of ART the mother-to-child transmission (MTCT) rate remains high at 8% at 18 months.
Objectives: The study aimed to assess the status of PMTCT among HIV-exposed infants and their mothers before pregnancy, during pregnancy, labour and delivery, and breastfeeding. To inform future interventions to mitigate the identified gaps in PMTCT care.
Methods: A cross-sectional study was conducted at Lobamba Clinic and RFM hospital from July to December 2021, 101 mother-infant pairs enrolled in the PMTCT programme and attending postnatal care (PNC). Data was collected from maternal and infant health care cards using a self-developed checklist. To analyse the descriptive statistics data frequency and percentage were used.
Results: The study found two infants tested positive for HIV at 6 weeks after birth. Our findings indicate gaps in the provision (clinical) and uptake (patient) of PMTCT of HIV among mothers and their infants including; failure to attend Antenatal Care (ANC), ART adherence, stopped ART, delayed HIV diagnosis in pregnancy, unavailability of Viral Load (VL) data, detectable VL, absence of Stepped-Up Adherence Counselling (SUAC), delayed reinitiating to ART, mixed feeding and delayed infant HIV testing.
Conclusion: To mitigate the identified gaps in PMTCT, women must be educated about the importance of maintaining a suppressed VL to reduce the risk of MTCT of HIV. Financial support from the government must be available to every pregnant woman, family involvement in maternal health services, introduction of home-based care services and regular home visitations by well-trained CHCWs during the ANC and PNC periods can assist in improving health service utilization.
Keywords: HIV exposed, PMTCT, MTCT, breastfeeding, interventions, CHCWs.

Abdula, M., Zeleke, T., & Shibeshi, W. (2017). Assessment of effectiveness of prevention of mother to child transmission of human immunodeficiency virus in Asella Hospital, Ethiopia. European Journal of Clinical Pharmacy, 19(3), 198-206. https://www.farmclin.com/seccion.asp?Id=8&articulo=1174
Abuhay, Y., Abebe, L., & Fentahun, N. (2014). Male involvement in prevention of mother to child transmission of HIV and associated factors among males in Addis Ababa, Ethiopia. American Journal of Health Research, 2(6), 338–343. http://dx.doi.org/10.11648/j.ajhr.20140206.13
Afolabi, A. Y., Bakarey, A. S., Kolawole, O. E., & Kola, O. J. (2018). Investigation of mother-to-child transmission of HIV in pregnancy and among HIV-exposed infants accessing care at a PMTCT clinic in southwest Nigeria. Journal of Immunoassay and Immunochemistry, 39(4), 403- 415. https://doi.org/10.1080/15321819.2018.1494607
American College of Obstetricians and Gynecologists. (2018). Labor and delivery management of women with human immunodeficiency virus infection. ACOG committee opinion no.751. Obstetrics & Gynecology, 132, 131–137. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/09/labor-and-delivery-management-of-women-with-human-immunodeficiency-virus-infection
Avert. (2020, August 25). HIV and AIDS in East and Southern Africa regional overview. https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/overview.
Bailey, H., Townsend, C. L., Semenenko, I., Malyuta, R., Cortina-Borja, M., & Thorne, C. (2018). Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine. Bulletin of the World Health Organization, 91(7), 491-500. http://dx.doi.org/10.2471/BLT.12.114405
Bekele, B. B., Dadi, T. L., & Tesfaye, T. (2019). The significant association between maternity waiting homes utilization and perinatal mortality in Africa: systematic review and meta-analysis. BMC Research Notes, 12(1). https://doi.org/10.1186/s13104-019-4056-z
Berhan, Z., Abebe, F., Gedefaw, M., Tesfa, M., Assefa, M., & Tafere, Y. (2014). Risk of HIV and associated factors among infants born to HIV positive women in Amhara region, Ethiopia: A facility based retrospective study. BMC research notes, 7(876). https://doi.org/10.1186/1756-0500-7-876
Beyene, G. A., Dadi, L. S., & Mogas, S. B. (2018). Determinants of HIV infection among children born to mothers on prevention of mother to child transmission program of HIV in Addis Ababa, Ethiopia: A case control study. BMC Infectious Diseases, 18(1), 327. https://doi.org/10.1186/s12879-018-3217-3
Cheng, Y., Sauer, B., Zhang, Y., Nickman, N. A., Jamjian, C., Stevens, V., & LaFleur, J. (2018). Adherence and virologic outcomes among treatment-naïve veteran patients with human immunodeficiency virus type 1 infection. Medicine, 97(2). https://doi.org/10.1097/MD.0000000000009430
Chotta, N. A. S., Mgongo, M., Msuya, S. E., Nyombi, B. M., Uriyo, J. G., Stray-Pedersen, B., & Stray-Pedersen, A. (2019). Prevalence and factors associated with HIV and syphilis infection among children aged 0-36 months in Kilimanjaro, Tanzania: A community-based cross-sectional study. Tropical Medicine and Health, 47(1). https://doi.org/10.1186/s41182-019-0183-4
Chouraya, C., Machekano, R., Mthethwa, S., Lindan, K., Mirira, M., Kudiabor, K., & Guay, L. (2018). Mother-to-child transmission of HIV and HIV-free survival in Swaziland: A community-based household survey. AIDS and Behavior, 22(1), 105-113. https://doi.org/10.1007/s10461-018-2121-6
Ciaranello, A. L., Park, J. E., Ramirez-Avila, L., Freedberg, K. A., Walensky, R. P., & Leroy, V. (2011). Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions. BMC Medicine, 9(59). https://doi.org/10.1186/1741-7015-9-59
Cluver, L. D., Toska, E., Orkin, F. M., Meinck, F., Hodes, R., Yakubovich, A. R., & Sherr, L. (2016). Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? AIDS care, 2(2), 73–82. https://doi.org/10.1080/09540121.2016.1179008
Davies, M. A., Gibb, D., & Turkova, A. (2016) Survival of HIV-1 vertically infected children. Current Opinion in HIV and AIDS, 11(5), 455-464. https://doi.org/10.1097/coh.0000000000000303
Desta, M. L., Saravanan, M., Hilekiros, H., Kahsay, A. G., Mohamed, N. F., Gezahegn, A. A., & Lopes, B. S. (2019). HIV prevalence and risk factors in infants born to HIV positive mothers, measured by dried blood spot real-time PCR assay in Tigray, Northern Ethiopia. BMC Pediatrics, 19, 257 (2019). https://doi.org/10.1186/s12887-019-1636-y
Ebuy, H., Bekele, A., & Redae, G. (2020). HIV testing, test results and factors influencing among infants born to HIV positive mothers in public hospitals of Mekelle City, North Ethiopia: a cross-sectional study. BMC Infectious Diseases, 20(1), 67. https://doi.org/10.1186/s12879-020-4790-9
Edmond, K. M., Yousufi, K., Anwari, Z., Sadat, S. M., Staniczai, S. M., Higgins-Steele, A., Bellows, A. L., & Smith, E. R. (2018). Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study. BMC Medicine, 16(1), 1-13. https://doi.org/10.1186/s12916-018-1092-9
Endalamaw, A., Demsie, A., Eshetie, S., & Habtewold, T. D. (2018). A systematic review and meta-analysis of vertical transmission route of HIV in Ethiopia. BMC Infectious Diseases, 18(1), 283. doi:10.1186/s12879-018-3189-3
Fowler, M. G., Coovadia, H., Herron, C. M., Maldonado, Y., Chipato, T., & Moodley, D. Efficacy and safety of an extended nevirapine regimen in infants of breastfeeding mothers with HIV-1 infection for prevention of HIV-1 transmission (HPTN 046). Journal of Acquired Immune Deficiency Syndromes, 65(3). 366-374. https://doi.org/10.1097/qai.0000000000000052
Friberg, I. K., Bhutta, Z. A., Darmstadt, G. L., Bang, A., Cousens, S., Baqui, A. H., Kumar, V., Walker, N., & Lawn, J.E. (2010). Comparing modelled predictions of neonatal mortality impacts using LiST with observed results of community-based intervention trials in South Asia. International Journal of Epidemiology, 39(1), i11-i20. https://doi.org/10.1093/ije/dyq017
Geme, J. W., Schor, N. F., & Behrman, R. E. (2016). Textbook of Pediatrics (20th ed). Philadelphia: Elsevier.
George, A., Menotti, E. P., Rivera, D., Montes, I., Reyes, C. M., & Marsh, D. R. (2009). Community case management of childhood illness in Nicaragua: transforming health systems in underserved rural areas. Journal of Health Care for the Poor and Underserved, 20(4), 99-115. https://doi.org/10.1353/hpu.0.0205
Hill, M. A. (2021, April 12). Gestational Age. Embryology. https://embryology.med.unsw.edu.au/embryology/index.php/Gestational_Age
Itiola, A. J., Goga, A. E., & Ramokolo, V. (2019). Trends and predictors of mother-to-child transmission of HIV in an era of protocol changes: Findings from two large health facilities in North East Nigeria. PLoS One, 14(11). https://doi.org/10.1371/journal.pone.0224670
Joint United Nations Programme on HIV/ AIDS. (2011, June). The global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Joint United Nations Programme on HIV/ AIDS. https://www.who.int/woman_child_accountability/ierg/reports/UNSAIDS_submission_iERG_2015.pdf.
Joint United Nations Programme on HIV/ AIDS. (2016, July). Prevention gap report. Joint United Nations Programme on HIV/ AIDS. http://www.unaids.org/en/resources/documents/2016/prevention-gap.
Joint United Nations Programme on HIV/AIDS. (2018). Joint United Nations Programme on HIV/AIDS.
Joint United Nations Programme on HIV/AIDS. (2019, July 22). UNAIDS calls on countries to accelerate efforts and close service gaps to end the AIDS epidemic among children and adolescents. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/july/2019722_PR_SFSFAF_report.
Joint United Nations Programme on HIV/AIDS. (2020, December 14). Country factsheets Eswatini | 2019. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/en/regionscountries/countries/swaziland.
Joint United Nations Programme on HIV/AIDS. (2020, July 6). Seizing the moment – Tackling entrenched inequalities to end epidemics. Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/en/resources/documents/2020/global-aids-report.
Karim, A. M., Admassu, K., Schellenberg, J., Alemu, H., Getachew, N., Ameha, A., Tadesse, L., & Betemariam, W. (2013). Effect of Ethiopia’s health extension program on maternal and newborn health care practices in 101 rural districts: a dose-response study. PloS One, 8(6). https://doi.org/10.1371/journal.pone.0065160
Kassa, G. M. (2018). Mother-to-child transmission of HIV infection and its associated factors in Ethiopia: A systematic review and meta-analysis. BMC Infectious Diseases, 18(1). https://doi.org/10.1186/s12879-018-3126-5
Kim, M. H., Ahmed, S., Preidis, G. A., Abrams, E. J., Hosseinipour, M. C., Giordano, T. P., Chiao, E. Y., Paul, M. E., Bhalakia, A., & Nanthuru, D. (2013). Low rates of mother-to-child HIV transmission in a routine programmatic setting in Lilongwe, Malawi. PLoS One, 8(5). https://doi.org/10.1371/journal.pone.0064979
Komtenza, B., Satyanarayana, S., Takarinda, K. C., Mukungunugwa, S. H., Mugurungi, O., Chonzi, P., Sithole, N., Bvochora, T., & Mushavi, A. (2019). Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing? PloS One, 14(3). https://doi.org/10.1371/journal.pone.0212848
Kourtis, A. P., Ibegbu, C. C., Theiler, R., Xu, Y. X., Bansil, P., Jamieson, D. J., Lindsay, M., Butera, S., & Duerr, A. (2007). Breast milk CD4+ T cells express high levels of C chemokine receptor 5 and CXC chemokine receptor 4 and are preserved in HIV-infected mothers receiving highly active antiretroviral therapy. The Journal of Infectious Diseases, 195(7), 965-972. https://doi.org/10.1086/512082
Lassi, Z. S., & Bhutta, Z. A. (2015). Community‐based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database of Systematic Reviews, 11. https://doi.org/10.1002/14651858.cd007754.pub2
Lincetto, O., Mothebesoane-Anoh, S., Gomez, P. and Munjanja, S. (2012) Opportunities for Africa’s Newborns. Antenatal Care.
www.who.int/entity/pmnch/media/publications/aonsectionIII_2.pdf
Medecins Sans Frontieres. (2017, August). Prevention of mother-to-child transmission (PMTCT) of HIV protocol. Médecins Sans Frontières. https://samumsf.org/sites/default/files/201803/2017_PMTCT%20handout%20Final%20version%2003_01_2018.pdf.
Medecins Sans Frontieres. (2018, October). MSF HIV/TB Clinical Guide (9th ed). Médecins Sans Frontières. https://samumsf.org/sites/default/files/2018-10/MSF%20HIVTB%20Clinical%20Guide%20for%20Primary%20Care%202018_5.pdf.
Ministry of Health of the Kingdom of Swaziland. (2015). Swaziland Integrated HIV Management Guidelines. Mbabane: The Government of the Kingdom of Eswatini.
Moges, N. A., Kassa, G. M., & Boneya, D. J. (2017). Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study. BMC Infectious Diseases, 17(1). https://doi.org/10.1186/s12879-017-2578-3
Musayón-Oblitas, Y., Cárcamo, C., & Gimbel, S. (2019). Counseling for improving adherence to antiretroviral treatment: a systematic review. AIDS care, 31(1), 4–13. https://doi.org/10.1080/09540121.2018.1533224
Ndarukwa, V., & Zunza, M. (2019). Combination antiretroviral treatment use in prevention of mother to child transmission programmes: 6-week HIV prevalence and relationship to time of antiretroviral treatment initiation and mixed feeding. Southern African Journal of Infectious Diseases, 34(1). https://doi.org/10.4102/sajid.v34i1.117
Newell, M. L., Coovadia, H., Cortina-Borja, M., Rollins, N., Gaillard, P., & Dabis, F. (2004). Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet, 364(9441). https://doi.org/10.1016/s0140-6736(04)17140-7
Ngwende, S., Gombe, N. T., Midzi, S., Tshimanga, M., Shambira, G., & Chadambuka, A. (2013). Factors associated with HIV infection among children born to mothers on the prevention of mother to child transmission programme at Chitungwiza Hospital, Zimbabwe, 2008. BMC Public Health, 13(1), 1181. https://doi.org/10.1186/1471-2458-13-1181
Nielsen-Saines, K., Watts, D. H., Veloso, V. G., Bryson, Y. J., Joao, E. C., Pilotto, J. H, Gray, G., Theron, G., Santos, B., Fonseca, R., Kreitchmann, R., Pinto, J., Mussi-Pinhata, M. M., Ceriotto, M., Machado, D., Bethel, J., Morgado, M. G., Dickover, R., Camarca, M., Mirochnick, M., Siberry, G., Grinsztejn, B., Moreira, R. I., Bastos, F. I., Xu, J., Moye, J., Mofenson, L. M., & NICHD HPTN 040/PACTG 1043 Protocol Team. (2012). Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. The New England Journal of Medicine, 366(25). https://doi.org/10.1056/nejmoa1108275
Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission. (2021, February 10). Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States. HIV.Gov. https://clinicalinfo.hiv.gov/en/guidelines/perinatal/antiretroviral-management-newborns-perinatal-HIV-exposure-or-HIV-infection.
Potty, R. S., Sinha, A., Sethumadhavan, R., Isac, S., & Washington, R. (2019). Incidence, prevalence and associated factors of mother-to-child transmission of HIV, among children exposed to maternal HIV, in Belgaum district, Karnataka, India. BMC Public Health, 19(1), 386. https://doi.org/10.1186/s12889-019-6707-3
The Government of the Kingdom of Eswatini. (2017, November). Swaziland HIV incidence measurement survey 2: A population-based HIV impact assessment SHIMS2 2016–2017. Mbabane: The Government of the Kingdom of Eswatini. http://phia.icap.columbia.edu/wpcontent/uploads/2017/11/Swaziland_new.v8.pdf
The Government of the Kingdom of Eswatini. (2018). Integrated HIV Management Guidelines. Mbabane: The Government of the Kingdom of Eswatini.
The Government of the Kingdom of Eswatini. (2018). The national multisectoral hiv and aids strategic framework (nsf) 2018 – 2023. Mbabane: The Government of the Kingdom of Eswatini. https://hivpreventioncoalition.unaids.org/wp-content/uploads/2019/06/Eswatini_NSF-2018-2023_final.pdf.
The Government of the Kingdom of Eswatini-Ministry of Health. (2018). HIV Annual Program Report 2018. Mbabane: The Government of the Kingdom of Eswatini.
Tippett Barr, B. A., van Lettow, M., van Oosterhout, J. J., Landes, M., Shiraishi, R. W., Amene, E., & Jahn, A. (2018). National estimates and risk factors associated with early mother-to-child transmission of HIV after implementation of option B+: A cross-sectional analysis. The Lancet HIV, 5(12), e688-e695. https://doi.org/10.1016/S2352-3018(18)30316-3
Tsehay, A. (2019). Risk of HIV and associated factors among infants born to HIV-positive women in northwest Ethiopia. The Ethiopian Journal of Health Development, 33(1), 53-58. https://www.ajol.info/index.php/ejhd/article/view/185930/175222
Tubiana, R., Le Chenadec, J., Rouzioux, C., Mandelbrot, L., Hamrene, K., Dollfus, C., Faye, A., Delaugerre, C., Blanche, S., & Warszawski, J. (2010). Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load< 500 copies/ml at delivery: A case-control study nested in the French perinatal cohort (EPF-ANRS CO1). Clinical Infectious Diseases, 50(4):585–596. https://doi.org/10.1086/650005
United Nations Children's Fund. (2018). Country office annual report 2018: Eswatini. United Nations Children's Fund. https://www.unicef.org/about/annualreport/files/Eswatini_(Swaziland)_2018_COAR.pdf
United Nations Children's Fund. (2018, September). Synthesis of secondary data on children and adolescents in Eswatini. United Nations Children's Fund. https://www.unicef.org/eswatini/media/616/file/Synthesis-Full-Report-2018.pdf.
Wilcher, R., Petruney, T. and Cates Jr, W. (2013). The role of family planning in elimination of new pediatric HIV infection. Current Opinion in HIV and AIDS, 8(5), 490. https://doi.org/10.1097/coh.0b013e3283632bd7
World Health Organization, (2004). Strategic framework for the prevention of HIV infections in infants in Europe (No. EUR/03/5048390). Copenhagen: World Health Organization Regional Office For Europe. https://apps.who.int/iris/handle/10665/107598
World Health Organization, United Nations Children’s Fund. (2016). Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva: World Health Organization. https://apps.who.int/iris/rest/bitstreams/1031940/retrieve
World Health Organization. (2016, June). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach (2nd ed). Geneva: World Health Organization. http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?ua=1
World Health Organization. (2017). Global guidance on criteria and processes for validation: Elimination of mother-to-child transmission of HIV and syphilis (2nd ed). Geneva: World Health Organization. http://apps.who.int/iris/bitstream/10665/259517/1/9789241513272-eng.pdf?ua=1.
World Health Organization. (2019). Preventing mother-to-child transmission of HIV in Eswatini. World Health Organization. https://www.who.int/features/2012/pmtct_swaziland/en/
World Health Organization. (2020, November 30). HIV/AIDS. Geneva: World Health Organization. https://www.who.int/news-room/q-a-detail/hiv-aids.
Wudineh, F., & Damtew, B. (2016). Mother-to-child transmission of HIV infection and its determinants among exposed infants on care and follow-up in Dire Dawa City, Eastern Ethiopia. AIDS Research and Treatment, 2016, 3262746. https://doi.org/10.1155/2016/3262746
Yitayew, Y. A., Bekele, D. M., Demissie, B. W., & Menji, Z. A. (2019). Mother to child transmission of HIV and associated factors among HIV exposed infants at public health facilities, Dessie Town, Ethiopia. HIV AIDS (Auckl), 11, 343-350. https://doi.org/10.2147/HIV.S221409