RESUMO
Objective@# To establish a comprehensive health evaluation index system for HIV-infected pregnant women in floating populations, so as to support the elimination of mother-to-child transmission of HIV. @*Methods@# The preliminary framework of the comprehensive health evaluation indicators was constructed based on literature review and focus group discussion. Experts from maternal and child healthcare, clinical medicine and public health were invited to participate in two-round Delphi consultations. The indicators were scored and weighed according to the importance, priority and measurability, and determined according to means and coefficients of variation of scores. The effectiveness of the consultation was evaluated by positive coefficient, authority coefficient and coordination coefficient.@*Results@# Twenty-six experts participated in this study, including 19 women. There were 5 experts aged 30-40 years, 14 experts aged 41-50 years, and 7 experts aged 51 years and over. There were 17 experts with a master degree and above. All experts had vice senior professional titles and above. The positive coefficients in the two rounds of consultations were 96.30% and 100.00%, the authority coefficients were 0.84 and 0.89, respectively. Finally, 4 primary indicators (individuals and families, disease factors, social environment, health service utilization) and 50 secondary indicators were identified, with the coefficients of variation ranging from 0.084 to 0.236 and the coordination coefficients ranging from 0.282 to 0.405 (all P<0.001). Among the secondary indicators, getting antiviral drugs at the place of residence was restricted to floating populations or not (0.780), HIV viral load during pregnancy (0.750), the registration of maternal and childbirth care manuals at the place of residence was restricted to floating populations or not (0.749), and first-trimester registration or not (0.738) had a high weight. @*Conclusion @#This index system can provide the reference for evaluating the health equity of HIV-infected pregnant and lying-in women in floating populations.
RESUMO
Objective@#To investigate the current status of syphilis treatment and its influencing factors among pregnant and lying-in women in Zhejiang Province, so as to promote the standardized treatment for pregnant and lying-in women with syphilis.@*Methods @#The sociodemographic characteristics ( age, educational level, ethnicity, marital status, occupation ), fertility ( gravidity, parity, number of children, and adverse pregnancy history ), gestational week at the first antenatal care visit and syphilis treatment ( treatment or not, standardized treatment or not, and antibody titer ) were collected from the pregnant and lying-in women with syphilis infections delivered in Zhejiang Province in 2018, based on the Zhejiang Provincial Information Management System for Prevention of Mother-to-Child Transmission of AIDS, Syphilis and Hepatitis B. Factors affecting the treatment of syphilis infections were identified using a structural-equation model.@*Results@#A total of 2 061 pregnant and lying-in women with syphilis infections were included, with a median age of 29 years and a mean gestational week at the first antenatal care visit of ( 14.33±11.85 ) weeks, and there were 844 women ( 40.95% ) diagnosed in early pregnancy ( <13 weeks of gestational age ). There were 1 978 cases ( 95.97% ) receiving syphilis treatment, and 1 616 cases ( 78.41% ) received standardized treatment. The structural-equation modeling analysis showed that the gestational age at the first antenatal care visit and fertility had direct impacts on the treatment of syphilis infections among pregnant and lying-in women, with standardized path coefficients of -0.187 and -0.157 (both P<0.05 ), respectively, and the sociodemographic characteristics affected the treatment of syphilis through the mediating role of fertility, with a standardized path coefficient of 0.070 ( P<0.05 ).@*Conclusions@#The proportion of syphilis treatment is more than 95% among pregnant and lying-in women in Zhejiang Province, which achieves the required process criteria for validation of elimination of mother-to-child transmission of HIV and syphilis. Gestational week at the first antenatal care visit, fertility status, and sociodemographic characteristics are factors affecting the treatment syphilis infections during pregnancy.