The study showed that the overall rate of HIV MTCT was 13.89% in Guangdong province from 2007 to 2010 after PMTCT interventions were implemented, and it was a MTCT rate of HIV similar to resource-limited region [8–10], and did not achieve the expectant goal of reducing the rate of HIV MTCT down to less than 5%. One of the main reasons of un-achieved the goal was the lower availability of the PMTCT interventions. The data of this article showed a lower and out-timely availability of ARVs of HIV positive mothers and their infants. Only 60.19% of HIV positive mothers received ARVs, and only 48.15% of them received ARVs during pregnancy, and merely 60.19% of them received triple ARVs regimen, and 80.56% of infants born to them received ARVs, and the formula feeding rate was 91.67%, and only 55.56% of mothers and their infants both received ARVs and formula feeding.
Consideration the conditions and surroundings of the PMTCT program, maybe many causes resulted in the lower availability of the PMTCT interventions. Such as, not enough HIV test ability of primary health service institutions, not enough training on PMTCT for primary medical personnel, HIV positive mothers initially participated antenatal care lately and even until to nearly delivery, following up difficulty for flowing population and worrying about discrimination, pregnant women do not know about the PMTCT interventions, and the ARVs for infants need to be imported and can’t be provided timely. A lot of literatures reported that many influencing factors can result in missing opportunities for prevention of mother-to-child transmission of HIV among HIV positive mothers and their infants, such as people’s knowledge about PMTCT, the antenatal service system and HIV test ability of facilities, following up mode [11–17]. The data of this study showed that 18.52% of HIV positive mothers confirmed HIV infected status during delivery, and 22.22% of them confirmed HIV infected status postnatal, and that resulted in lower availability of ARVs.
Although there was no significant difference of overall HIV-MTCT rate between mothers or infants received ARVs and those non-received ARVs, the data showed that mothers and their infants neither received ARVs compared to those both received ARVs, mothers received non-triple ARVs compared to those received triple ARVs, and mothers non-received ARVs during pregnancy compared to those received ARVs during pregnancy, can increase the HIV-MTCT rate, and the OR value was 4.38 (95% CI: 1.11-17.40), 9.75 (95% CI: 1.07-89.20) and 4.32 (95% CI: 1.09-17.15) respectively. If HIV positive mothers receive ARVs following the referred regimen, the HIV-MTCT rate could be decreased to 2.5%; and if HIV positive mothers received ARVs during pregnancy, the HIV-MTCT rate could be decreased to 5.77%, and the effects of PMTCT were similar to that in developed countries [8, 10, 18, 19]. The data illustrated that HIV positive mothers and their infants received ARVs timely and routinely can help to decrease the HIV MTCT rate significantly, and the helping was limited if they received ARVs out-time or un-routinely.
The data of this study showed that mixed feeding increased the opportunity of HIV-MTCT compared to formula feeding (OR=10.88, 95% CI: 1.65-71.86), and decreased the opportunity of HIV-MTCT compared to breast feeding (OR=0.88, 95% CI: 0.82-0.95)). The study of Gerardo et al. revealed that universal ARV therapy to HIV-infected pregnant women is able to reduce mother-to-child transmission to less than 5%, although breastfeeding can increase the rate of HIV transmission, formula feeding produces malnutrition during the first month of life, increases mortality compared to breastfeeding . The results of whether breastfeeding increased the rate of HIV MTCT was different, but only 4 infants received breastfeeding in our data, it needed more samples to be further analyzed.
Siobhan et al. reported that there was no association between mode of delivery and HIV MTCT, which was consistent with our findings . But we found that when HIV positive mothers and their infants received ARVs and formula feeding, and plus elective C-section could further reduce HIV MTCT. Mothers and their infants both received ARVs and formula feeding could reduce HIV MTCT down to 6.67% (4/60), but HIV MTCT was eliminated in 26 mothers and their infants who received all the interventions including received ARVs, elective C-section, and formula feeding.
The review of Tudor et al. described that integrated PMTCT services could reduce MTCT effectively . The study of Ngozi et al. showed that holistic but cost effective preventive interventions help in reducing the rate of mother-to-child transmission of HIV even in economically-developing settings . Turan et al. found that PMTCT of HIV and antenatal care integration in pregnancy might improve the implementation and effectiveness of PMTCT in rural area . All of above mentioned illustrated that it was important to strengthen the implementation of PMTCT program to increase the availability of interventions in Guangdong province for achieving the goal of elimination of new infections among children by 2015, which was similar to the problems of developing country .
A number of clinical trials have showed that MTCT can now be reduced to less than 2 percent from a possible 25–30 percent without any intervention . With the cumulation of evidence of PMTCT, the recommendation protocol of PMTCT is kept on update. The finding of this study denominated that the protocol of PMTCT program in Guangdong from 2007 to 2010 could effectively reduce the rate of MTCT, but that effectiveness were heavily cut down by the lower availability of integrated PMTCT interventions. Although recently the evidence showed that the breastfeeding could be use for PMTCT in many developing countries, but the formula-feeding was more benefit to PMTCT in the setting of Guangdong province.
In addition, the data of this article showed that there was no significant decrease of HIV MTCT rate in the funded PMTCT regions compared to non-funded PMTCT regions (11.29% vs. 17.39%) after the PMTCT program was launched in Guangdong. And the loss to follow-up among infants was the main obstacle of effective evaluation of PMTCT program, there were 196 pairs of HIV positive mothers and their infants were reported form 2007 to 2010 in Guangdong, only 55.1% (108/196) of them were eligible. All of the excluded objects were due to loss to follow-up the HIV infectious status of infants, which mostly because of population flowing and the parent was afraid of impact to the life of their child after the HIV infectious status was exposed. According to the information of mothers’ reported cards, in 88 subjects who lost to follow up, the mean age of mother was 28.78±5.28 years, which was higher than the mean age of targeted subject (t=2.13, p=0.03); But the distributions of marital status, education level, occupation, and the rate of ARV prophylaxis were no significant difference respectively between lost follow up mothers and targeted mothers (p>0.05). And 67.05% (59/88) of mothers and 79.55% (70/88) of their infants ever received ARVs among 88 subjects who lost to follow up. According to these data, it was suppose that the estimation of MTCT rates in this study was acceptable.