1
Tbilisis saxelmwifo samedicino universiteti
sazogadoebrivi jandacvis saerTaSoriso skola
dedidan bavSvze aiv infeqciis gadacemis codnis donis
Sefaseba reproduqciuli asakis mqone qalebSi
saqarTveloSi
maia xuciSvili MD
naSromi warmodgenili magistris xarisxis mosapoveblad
samecniero xelmZRvaneli: Mmaia buwaSvili MD, MS, PhD
Tbilisi - 2012, saqarTvelo
2
Sinaarsi..........................................................................................................................................................................2
1. Sesavali (problemis aqtualuroba)............................................................................4
1.1 infeqciis gavrcelebis gzebi...........................................................................................6
1.1.1 aiv infeqciis dedidan bavSvze gadacema............................................................6
1.1.2 aiv infeqcis prevencia..........................................................................................................8
1.1.3 dedidan bavSvze gadacemis prevencia....................................................................8
2. aiv infeqcia ganviTarebul qveynebSi..........................................................................9
2.1 aiv infeqcia ganviTarebad qveynebSi.........................................................................10
2.2 problemis aqtualuroba aRmosavleT evropis da centraluri
aziis regionSi.......................................................................................................................................10
2.3 aiv infeqciis gavrceleba saqarTveloSi...........................................................11
3. problemasTan dakavSirebiT Catarebuli kvlevebi.....................................12
3.1 ganviTarebul qveynebSi Catarebuli kvlevebi...............................................12
3.2 ganviTarebad qveynebSi Catarebuli kvlevebi................................................14
3.2.1 afrikaSi Catarebuli kvlevebi..................................................................................14
3.2.2 aziaSi Catarebuli kvlevebi........................................................................................16
3.3 aRmosavleT evropis regionSi Catarebuli kvlevebi............................18
3.4 kvlevebi saqarTveloSi........................................................................................................19
4. kvlevis mizani da amocanebi.............................................................................................20
4.1 kvlevis mizani...............................................................................................................................20
4.2 kvlevis amocanebi.....................................................................................................................20
3
5. kvlevis meTodologia............................................................................................................21
5.1 SerCevis zoma da kvlevis adgili..........................................................................21
5.2 kvlevaSi CarTvis procedurebi.................................................................................21
5.3 kvlevis instrumenti.............................................................................................................21
5.4 SerCevis kriteriumebi.........................................................................................................22
6. cvladebi..............................................................................................................................................22
6.1 ZiriTadi gamosavali cvladi......................................................................................22
6.2 prediqtori cvladebi.........................................................................................................23
7. statistikuri analizi da Sedegebi........................................................................23
7.1 aRwerilobiTi statistika (univariaciuli analizi).........................24
7.1.1 demografiuli maCveneblebi.......................................................................................24
7.1.2 reproduqciuli maCveneblebi...................................................................................25
7.2 bivariaciuli analizi.......................................................................................................26
7.3 multivariaciuli analizi...........................................................................................28
8. diskusia..............................................................................................................................................29
9. kvlevis susti da Zlieri mxareebi.........................................................................30
10. daskvna da rekomendaciebi.............................................................................................31
11. cxrilebi..........................................................................................................................................33
12. gamoyenebuli literatura...........................................................................................40
13. danarTi (kiTxvari)...............................................................................................................44
4
1. Sesavali
aiv infeqcia sazogadoebrivi jandacvis erT-erTi mniSvnelovani
problemaa, rogorc samedicino, ise socialuri TvalsazrisiT. igi
aqtualuria rogorc individualur da sazogadoebriv, aseve qveynebis da
regionebis doneze mTels msoflioSi. Aadamianis imunodeficitis virusi
Tanabrad emuqreba yvelas asakis, sqesis, erovnebis da ganaTlebis
miuxedavad. maRalaqtiuri antiretrovirusuli (arv) mkurnalobis da
mravali prevenciuli RonisZiebebis wyalobiT msoflios ganviTarebul
qveynebSi aiv infeqciis axali SemTxvevebis raodenobis mxriv situacia
SedarebiT stabiluria. janmrTelobis msoflio organizaciis (janmo)
2010 wlis monacemebiT, dabali da saSualo Semosavlebis qveynebSi
mcxovrebi 6.6 mln. Aaiv inficirebuli Rebulobs arv mkurnalobas, 7
milioni adamiani ki kvlav am momsaxurebis molodinSia da Sesabamisad
ganviTarebadi msofliosTvis mkurnalobis sakiTxi kvlav seriozul
problemad rCeba. U
ukanaskneli sami aTwleulis ganmavlobaSi msoflioSi SidsiT
daaxloebiT 25 mln. adamiani gardaicvala. bevri afrikuli qveynisTvis
igi dResac rCeba sikvdilobis nomer pirvel mizezad, msoflios
masStabiT ki sikvdilis yvela mizezTa Soris Sidsi meoTxe adgilzea [1].
WHO, UNAIDS, UNICEF–is 2010 wlis monacemebiT msoflioSi aiv
inficirebulTa raodenobam 34 mln. Seadgina (31,600,000 – 35,200,000), maT
Soris 15 wlamde asakis bavSvi 3.4 mln. (3,000,000 – 3,800,000). amave periodSi
dafiqsirebulia 2.7 mln. (2,400,000 – 2,900,000) axali SemTxveva, maTgan 15
wlamde asakis 390, 000 (340,000–450,000) bavSvi [2]. globalurad aiv
inficirebulTa axali SemTxvevebis (2.2 mln. 2001 wels da 1.9 mln. 2010
wels) da sikvdilobis Semcirebis (2.2 mln. 2005w. 1.8 mln. 2010w. maT Soris
250,000 15 wlamde asakis bavSvi) miuxedavad mTel rig qveynebSi kvlav
aRiniSneba epidemiis aRmavlobis tendencia. kerZod, Sua da CrdiloeT
afrikaSi gaizarda axlad inficirebulTa yovelwliuri maCvenebeli
5
(34,000 2001w. da 59,000 2010w). 2008 wlidan aiv incidentobis mateba
SeimCneva aRmosavleT evropisa da Sua aziis regionSic. Sesabamisad
maRalia adamianis imunodeficitis virusTan asocirebuli sikvdilobis
maCvenebelic, romelic 2001 welTan SedarebiT gazrdilia 10-jer (7,800 -
dan 90,000 -mde), amave periodSi SidsTan dakavSirebuli mizeziT
sikvdilobam 60%-iT moimata Sua-aRmosavleT da CrdiloeT afrikaSi
(22,000 -dan [9,700 – 38,000] 35,000-mde [25,000 – 42,000]), xolo aRmosavleT
aziaSi TiTqmis gaormagda (24,000 -dan [16,000 – 45,000] 56,000 -mde [40,000 –
76,000]) [2].
gansakuTrebul problemas warmoadgens is, rom inficirebulTa didma
nawilma ar icis, rom aiv matarebelia [1.2]. amas isic emateba, rom
yoveldRiurad sul ufro meti Sromisunariani, sxvadasxva profesiis
adamiani inficirdeba, rac maRali gavrcelebis qveynebisTvis seriozul
ekonomikur problemas warmoadgens, am qveynebSi ekonomikuri zrdis tempi
yovelwliurad 1.2 %-iT ecema.
აივ ინფექცია seriozuli demografiuli problemacaa, radgan misi
upirvelesi msxverplni axalgazrda reproduqciuli asakis adamianebi
arian. am mxriv yvelaze mZime Sedegi ki sicocxlis saSualo xangZlivobis
Semcirebaa, romelic eqspertTa azriT maRali prevalentobis qveynebSi
kidev ufro Semcirdeba.
msoflioSi inficirebis axali SemTxvevebis TiTqmis naxevari
axalgazrdebze modis, amasTan, Tu epidemiis dasawyisSi aiv inficirebuli
mamakacebis raodenoba mniSvnelovnad aRemateboda inficirebuli qalebis
raodenobas, ukanasknel wlebSi proporcia dairRva da msoflioSi აივ
inficirebulTa TiTqmis naxevari qalebma da gogonebma Seadgines. es
tendencia gansakuTrebiT SesamCnevia msoflios im regionebSi, sadac
dominirebs aiv - is gadacemis heteroseqsualuri gza [3]. mniSvnelovnad
moimata inficirebul orsulTa da axalSobilTa raodenobam, am
6
ukanasknelis mizezi ki 90 % SemTxvevaSi virusis dedidan bavSvze
gadacemaa.
1.1 aiv infeqciis gavrcelebis gzebi
rogorc cnobilia, arsebobs aiv infeqiis gavrcelebis sami ZiriTadi
gza: sqesobrivi, parenteraluli da perinataluri. sqesobrivi gziT
dainficireba SesaZlebelia rogorc hetero, aseve homoseqsualuri
kontaqtebiT. dRes msoflioSi infeqciis gavrcelebis wamyvan mizezad
swored sqesobrivi gadacema miiCneva.
rac Seexeba parenteralur gadacemas, igi SesaZlebelia sisxlis an
sisxlis produqtebis gadasxmiT (am dros virusis gadacemis riski 95%-ze
maRalia), inექციურ narkomanebSi saerTo Spricebisa da nemsebis
gamoyenebiT (erT ineqciaze gadacemis riski 0.67%), samedicino
dawesebulebebSi arasteriluri samedicino iaraRebis gamoyenebiT,
samedicino personalis mier dabinZurebuli nemsis CxvletiT an sxva
basri instrumentebiT sxeulis dazianebiT (dainficirebis riski 0.4%) da
SedarebiT iSviaTad dabinZurebuli sisxlis lorwovan garsebze
moxvedriT [4]. parenteraluri gadacemis yvelaze xSiri mizezi mTels
msoflioSi inექციური narkomaniaa.
1.1.1 aiv infeqciis dedidan bavSvze gadacema
dResdReobiT, aiv infeqciis dedidan bavSvze gadacema mTel rig
qveynebSi kvlav rCeba infeqciis gavrcelebis mniSvnelovan gzad.
kombinirebuli prevenciuli RonisZiebebis gamoyenebiT vertikaluri
transmisiis 2% mde Semcirebis miuxedavad, dedidan bavSvze gadacemis
SemTxvevebi mainc aRiniSneba mTels msoflioSi, gansakuTrebiT ki aiv
infeqciis maRali prevalentobis qveynebSi, romelzec modis dedidan
7
bavSvze virusis gadacemis yvela SemTxvevaTa 95% [5]. 2010 wlis
monacemebiT msoflioSi daaxloebiTN3.4 mln. 15 wlamde askis bavSvia
inficirebuli da am SemTxvevaTa daaxloebiT 90%-is mizezi virusis
dedidan vertikaluri gadacemaa [6]. zogadad perinataluri gadacemis
riski 25-30%-ia, igi SesaZlebelia orsulobis, mSobiarobis da aseve
postnatalur periodSi ZuZuTi kvebisas. dainficirebul bavSvTa 80%-Si
virusis gadacema xdeba mSobiarobisas. prevenciuli Carevis da
mkurnalobis gareSe yoveli inficirebuli dedis sami axalSobilidan
erTi inficirebuli ibadeba an inficirdeba dabadebis Semdeg dedis rZiT
kvebisas. antenataluri inficirebis mniSvnelovani risk-faqtori
SemTxvevaTa 16-29%-Si ZuZuTi kvebaa [7].
Sansi dainficirebisa ganviTarebul qveynebSi 15-30%, xolo
ganviTarebadSi 30-45%-ia [5.7]. bavSvTa daaxloebiT 20-25% inficirdeba
orsulobis dros. am periodSi inficirebis ZiriTadi risk faqtorebidan
aRsaniSnavia bavSvis mier inficirebuli amnionuri siTxis gadaylapva,
dedis serokonversia, maRali virusuli datvirTva, malnutricia, sxva
sqesobrivi gziT gadamdebi daavadebebi (sggd) da arasaTanado arv
mkurnaloba an misi ar arseboba.
mSobiarobisas moqmedi faqtorebidan, romlebic zrdis gadacemis
risks, mniSvnelovania vaginaluri mSobiaroba, samSobiaro gzebis
qsovilebis dazianeba da qorioamnionitisi.
sagulisxmoa is faqti, rom drois monakveTi inficirebidan
daavadebis ganviTarebamde da Sesabamisad sikvdilamde bavSvebSi
gacilebiT moklea mozrdilebTan SedarebiT. bavSvebis 20-25% kvdeba
sicocxlis pirveli ori wlis ganmavlobaSi, xolo 60-70% ver aRwevs
dabadebis 5 wlisTavs [8].
8
1.1.2. aiv infeqcis prevencia
aiv infeqciis gavrcelebis winaaRmdeg brZolis yvelaze warmatebuli
meTodi axali SemTxvevebis Tavidan acilebaa. Asxva mraval
mimarTulebaTa Soris, am mxriv mniSvnelovania inficirebuli dedidan
virusis bavSvze gadacemis Semcireba orsulobis, mSobiarobis da ZuZuTi
kvebisas. rogorc cnobilia qalebze virusis gadacemis riski daaxloebiT
10-jer ufro maRalia mamakacebTan SedarebiT. bolo wlebis monacemebiT
aiv inficirebuli, gansakuTrebiT, axalgazrda reproduqciuli asakis
qalTa ricxvi sagrZnoblad izrdeba. mraval mizezTa Soris, romlebic
zrdian qalTa inficirebis risks, aRsaniSnavia stigma da diskriminacia,
romelic ar aZlevT maT Sesabamisi ganaTlebis miRebis saSualebas, aseve
mravali religiuri, eTnikuri Tu socialuri sakiTxi, romelTa gamoc
qalebs ar aqvT piradi cxovrebis gankargvis ufleba da xSir SemTxvevaSi
Zaladobis msxverplni arian [9].
1.1.3 dedidan bavSvze gadacemis prevencia
prevenciis yvelaze warmatebul meTodad mTels msoflioSi
miCneulia antiretrovirusuli mkurnaloba da profilaqtika (rogorc
dedis, aseve bavSvis), sakeisro kveTa da ZuZuTi kvebisgan Tavis Sekaveba
[7]. perinataluri prevencia gulisxmobs reproduqciuli asakis qalTa da
maTi partniorebis codnis donis da cnobierebis amaRlebas zogadad aiv
infeqciis, gadacemis gzebis, usafrTxo seqsis, nebayoflobiTi
konsultaciis da testirebis Sesaxeb. pirveladi prevencia moicavs qalTa
informirebas Tanamedrove kontraceptuli saSualebebis (kondomi da a.S),
arasasurveli orsulobis Tavidan acilebis da sggd-s Sesaxeb. sworad
warmarTuli pirveladi prevencia aseve gulisxmobs maRali riskis
jgufebis maqsimalurad mocvas prevenciuli RonisZiebebiT, rogoricaa
seqsmuSakebi, axalgazrda gogonebi da qalebi, romlebic SesaZlebelia
gaxdnen sqesobrivi Zaladobis da narkomaniis msxverplni. samecniero da
9
teqnikuri progresis damsaxurebiT, dRes ganviTarebul qveynebSi swrafi
testirebis da maRali aqtivobis antiretrovirusuli Terapiis
saSualebiT Sidsis virusis dedidan bavSvze gadacemis incidentobam
sagulisxmod iklo [8]. arv mkurnalobis Sesabamisi dozirebis da reJimis
pirobebSi SesaZlebelia vertikaluri gadacemis 50%-iT Semcireba. xolo
Tu amas daemata sakeisro kveTa da mSobiarobis Semdgom ZuZuTi kvebisgan
Tavis Sekaveba, prevenciuli Sedegi gacilebiT maRalia.
2. aiv infeqcia ganviTarebul qveynebSi
2010 wlis monacemebiT amerikis SeerTebul StatebSi da dasavleT da
centralur evropaSi daaxloebiT 2.2 mln. inficirebuli adamiani
cxovrobs, maT Soris naxevarze meti (1.2 mln) amerikaSi. regionSi
yovelwliurad 88,000 adamiani inficirdeba, aqedan aSS – Si 50,000 [10]. 15
wels zemoT inficirebuli qalebis raodenobaa 310,000, SidsiT
gardacvlilTa ricxvi ki 17,000 [11]. iseT qveynebSi, rogoricaa bulgareTi,
CexeTi, slovenia, slovakeTi, litva, ungreTi, germania da didi
britaneTi, inficirebulTa ricxvi TiTqmis gaormagda. Tumca, meores
mxriv, rumineTSi, portugaliasa da latviaSi es maCvenebeli 20%-iT
Semcirda, rac garkveulwilad efeqturad ganxorcielebuli prevenciuli
Carevebis, kerZod, drouli diagnostirebis da adre dawyebuli arv
mkurnalobis Sedegia. A
UNAIDS 2006 wlis monacemebiT kanadaSi yvela dadebiTi testis 34%
modis qalebze, maT Soris 65% 19-49 wlamde asakisaa. amave wyaros
monacemebiT inficirebuli qalebis 25% -ma ar icis amis Sesaxeb. yovelive
es mowmobs, rom im qveynebSic ki, sadac zogadad aiv infeqciis da
konkretulad dedidan bavSvze virusis gadacemis prevenciuli
RonisZiebebi kargad aris dagegmili am mxriv jer kidev bevri problema
rCeba [12].
10
2.1 aiv infeqcia ganviTarebad qveynebSi
gacilebiT rTuli mdgomareobaa ganviTarebad qveynebSi,
gansakuTrebiT, afrikis kontinentze. miuxedavad imisa, rom sub-saharul
afrikaSi dedamiwis populaciis mxolod 10% cxovrobs, msoflioSi yvela
aiv inficirebulTa 2/3 da inficirebul bavSvTa 90% swored am regionze
modis. am qveynebSi aiv infeqciis gadacemis ZiriTadi gza
heteroseqsualuri kontaqtebia. aranakleb sagangaSo situaciaa aziaSi,
romelic didi xnis manZilze iTvleboda aiv infeqciisgan Tavisufal
zonad, amJamad ki, rogorc zemoT aRvniSneT, axali SemTxvevebis
gamovlenis mxriv azia erT-erT pirvel adgilzea. SemaSfoTebeli
statistikaa samxreT da samxreT-aRmosavleT aziis qveynebSi. 2005 wlis
bolosaTvis aziaSi inficirebulTa raodenobam 8.3 milions miaRwia [13].
2.2 problemis aqtualoba aRmosavleT evropis da centraluri aziis
regionSi
CvenTvis gansakuTrebiT sainteresoa aRmosavleT evropis da
centraluri aziis regioni, sadac 2000-2009 wlebSi inficirebulTa
raodenoba TiTqmis gaormagda da 1.4 mln. Seadgina. aRsaniSnavia, rom
incidentobis matebasTan erTad, 2001 welTan SedarebiT, 4-jer gaizarda
SidsTan asocirebuli mizeziT gamowveuli sikvdilis SemTxvevaTa
ricxvic (18,000-2001, 76,000-2010w.). sagulisxmoa is faqti, rom regionis
SemTxvevaTa 90% ruseTis federaciasa da ukrainaze modis. regionis
masStabiT ki ukrainas aiv infeqciis prevalentobis yvelaze maRali
maCvenebeli 1.1% (1.0-1.3) aqvs. 2001 wlidan gaormagebulia yovelwliurad
gamovlenili SemTxvevebis ricxvic. regionSi 2001 welTan SedarebiT
infeqciis 250%-iani matebaa (240,000-dan 2001 weli 1.5 mln 2010 wels), rac
gansakuTrebiT SeiniSneboda 2007-2008 wlebSi, yovelwliurad 130,000-iani
11
matebiT. eqspertebi Tvlian, rom am qveynebSi piki inficirebisa jer ar
damdgara. aRmosavleT evropasa da centralur aziaSi inficirebul
adamianTa ricxvi 2-jer metia, vidre dasavleT da centralur evropaSi
erTad. inficirebuli mozrdili adamianebis 35% qalia, da rac yvelaze
sagangaSoa, 4-jer moimata inficirebul bavSvTa raodenobam (17,000) da
Sesabamisad am mizeziT gamowveuli bavSvTa sikvdiloba gaizarda 2-jer
(500-dan 1,200-mde) [14].GregionSi gavrcelebis ZiriTadi gza intravenuri
narkomania da sqesobrivi kontaqtia. ruseTis seqsmuSakebis erTi mesamedi
intravenuri narkomania. es orive mizezi kombinaciaSi zrdis rogorc
zogadad mosaxleobis, aseve qalebis da Sesabamisad bavSvTa inficirebis
risks.
2.3 aiv infeqciis gavrceleba saqarTveloSi
miuxedavad imisa, rom saqarTvelo dabali prevalentobis qveyanaTa
ricxvs miekuTvneba, regionis farglebSi mWidro socialuri da
geografiuli kontaqtebi, problemas aqtualurs xdis
saqarTvelosTvisac. Sidsis centris monacemebiT 2012 wlis 1 ianvrisaTvis
centrSi registrirebulia 3,115 SemTxveva, maT Soris 2011 wels
registrirebulia 389 axali SemTxveva, arv mkurnalobaze imyofeba 1,090
pacienti maT Soris 37 bavSvi. rac Seexeba dedidan bavSvze gadacemas, is
saqarTveloSi aiv-iT yvela gziT inficirebis SemTxvevaTa jamuri
raodenobis 2.2 %-s Seadgens [15]. qveyanaSi matulobs yovelwliurad
inficirebulTa ricxvi.
saqarTveloSi janmrTelobisa da socialuri programebis saagentos
Tanaxmad, yvela qals, dedidan bavSvze gadacemis prevenciis farglebSi,
antenataluri zrunvis momsaxurebis miRebisas utardeba konsultacia da
aiv testireba, Sesabamisad, WHO, UNAIDS da UNICEF-is monacemebiT
izrdeba arv mkurnalobaze myofi orsuli qalebis raodenobac. CvenTan
12
aiv infeqciis gavrcelebis ZiriTadi gza, msgavsad regionis sxva
qveynebisa, aris parenteraluri gadacema intravenuri narkomaniis saxiT,
Tumca bolo dros SeiniSneba heteroseqsualuri gadacemis proporciis
matebac. evropis daavadebaTa kontrolisa da prevenciis (ECDC) centris
monacemebiT saqarTvelo SemTxvevaTa dabali ricxvis miuxedavad, aiv
infeqciis gavrcelebis mxriv ganixileba, rogorc maRali riskis qveyana
da mosalodnelia prevalentobis swrafi zrda ineqciuri narkomaniis
farTod gavrcelebis, aseve B da C hepatitis (rogorc gadacemis saerTo
gzebis mqone infeqciebis), maRali prevalentobis da mezobel, აივ
ინფექციის mxriv maRali incidentobis da prevalentobis mqone qveynebTan,
mWidro kontaqtis gamo [16].
3. dedidan bavSvze aiv infeqciis gadacemis sferoSi Catarebuli
samecniero literaturis mimoxilva
Tanamedrove msoflioSi aiv inficirebulTa raodenobis da gadacemis
heteroseqsualuri gzis matebasTan erTad sakmaod maRalia
reproduqciuli asakis qalTa dainficirebis da Sesabamisad, dedidan
bavSvze aiv gadacemis riski.Aaqedan gamomdinare, didi mniSvneloba eniWeba
qalTa informirebulobis amaRlebas SidsTan dakavSirebiT. Mmsoflios
masStabiT mravali kvlevaa Catarebuli am infeqciis Sesaxeb codnis
donis, gadacemis gzebis da dedidan bavSvze virusis gadacemis prevenciis
Sesaxeb.
3.1 ganviTarebul qveynebSi Catarebuli kvlevebi
amerikis SeerTebuli Statebi erT-erTi im qveyanaTgania, sadac didi
xania warmoebs dedidan bavSvze gadacemis prevenciuli RonisZiebebi, 2001
wels daavadebaTa kontrolis centris (CDC) iniciativiT daigegma aiv
13
prevenciis axali strategia, romlis mizanic qveyanaSi yovelwliurad
axali SemTxvevebis 50%-iT Semcireba iyo. es RonisZieba iTvaliswinebda
adreuli diagnostikis barierebis Semcirebas, im adamianTa proporciis
gazrdas romlebmac icodnen TavianTi daavadebis Sesaxeb da aseve im
orsuli qalebis raodenobis matebas, romlebic vertikaluri gadacemis
prevenciis mizniT airCevdnen arv mkurnalobas. am mizniT aSS
yovelwliurad xarjavda 900 mln dolars. 2006 wels am dafinansebis
Sedegebis Sesaswavlad Catarebulma kvlevam aCvena, rom dafinansebis
zrdasTan erTad izrdeboda aiv testirebis raodenoba (P=.009) da aseve
dedidan bavSvze gadacemis (MTCT) codnis done (P=.002) [17].
ganviTarebul qveynebSi Catarebuli kvlevebi gviCvenebs, Tu ramdenad
mniSvnelovania dedidan bavSvze infeqciis gadacemis da misi Tavidan
acilebis prevenciuli saSualebebis Sesaxeb codnis donis amaRleba.
belgiaSi Catarebuli kvleva mowmobs, rom dedidan bavSvze infeqciis
gadacema mniSvnelovnad Semcirda masze prevenciis Sesaxeb codnis donis
amaRlebiT. 1983-1993 wlebSi vertikaluri gadacema iyo 10%, xolo 1999-2002
wlebSi 4.7%, rac profilaqtikuri Carevebis damsaxurebaa. didi
miniSvneloba eniWeba arv mkurnalobis xangZlivobas. im orsulebSi,
romlebic arv preparatebs Rebulobdnen erT Tveze metxans, gadacemis
sixSire naklebia (1.7%), im orsulebTan SedarebiT, romlebmac Caitares
mkurnalobis ufro moklevadiani kursi (13.3%), xolo mkurnalobis gareSe
dedidan bavSvze gadacemis riski 4-jer metia (P=.05) [18].
arv mkurnalobis TvalsazrisiT sainteresoa dasavleT evropuli
kolaboratoruli kvlevis Sedegebi [19]. Seswavlil iqna 5,238 deda-bavSvis
wyvilis 1985-dan 2007 wlamde monacemebi, ris Sedegadac daaskvnes, rom
maRalaqtiuri arv mkurnalobis danergvasTan erTad, arCeviTi sakeisro
kveTis, rogorc dedidan bavSvze gadacemis prevenciis erT-erTi formis
gazrdilma sixSirem mkveTrad daiklo.
14
israelSi, 2000-2005 wlebSi, Sidsis 6 centrSi, Catarebulma
retrospeqtulma kvlevam, romelmac Seiwavla 241 aiv inficirebuli qalis
300 orsuloba, aCvena, rom vertikaluri gadacemis mTliani sixSire iyo
3.6% da igi mkacrad iyo asocorebuli dagvianebul aiv
diagnostirebasTan, CD4 limfocitebis naklebobasTan, perinataluri arv
mkurnalobis deficitTan da kidev erTxel daaskvna, rom, dedis da
bavSvis arv mkurnaloba orsulobis, mSobiarobis da dabadebis Semdgom
periodSi aris gadamwyveti dedidan bavSvze virusis gadacemis efeqturi
prevenciisTvis, da rom es zrdis vertikaluri gadacemis codnis,
adreuli aiv skriningis, diagnostirebis da mkurnalobis saWiroebas [20].
italiaSi, kerZod, romSi Catarebuli kvlevis farglebSi,
swavlobdnen aiv vertikaluri gadacemis riskis codnis dones da Tu ras
fiqroben qalebi mkurnalobis axali meTodis rolze riskis SemcirebaSi.
sul gamokvleul iqna 152 aiv inficirebuli qali, romelTagan 13.8%
Tvlida, rom vertikaluri gadacemis riski 100%-ia, 44.1% - 50-80%, 23%-is
azriT ki igi 10-50% iyo, samwuxarod, mxolod 14.5%-ma icoda, rom riski
5%-ze naklebia. gamokiTxul qalTa 53.9% miiCnevs arv mkurnalobas
vertikaluri gadacemis efeqtur prevenciul saSualebad, xolo 41.4% ki
mas uSedegod Tvlis [21]. es monacemebi xazs usvams yvela reproduqciuli
asakis aiv inficirebul qalebSi perinataluri transmisiis prevenciis
Sesaxeb konsultaciebis Catarebis da codnis donis amaRlebis
saWiroebas.
3.2 ganviTarebad qveynebSi Catarebuli kvlevebi
3.2.1 afrikaSi Catarebuli kvlevebi
msgavsi tipis mravali kvlevaa Catarebuli gaviTrebad qveynebSi,
sadac gacilebiT didia dedidan bavSvze gadacemis sixSire. saintersoa
sub-saharul afrikaSi, kerZod Bburkina fasoSi, rogorc erT-erTi
15
yvelaze maRali prevalentobis qveyanaSi, Catarebuli retrospeqtuli
kohortuli kvleva, romelic aRwers, Tu ramdenad mniSvnelovania aiv
inficirebis adreuli diagnostika da Sesabamisad maRalaqtiuri arv
mkurnalobis adreuli dawyeba. erTmaneTs Seadares 18 Tviani da
moklevadiani arv mkurnalobis Sedegebi vertikaluri gadacemis
prevenciis farglebSi. SerCeul iqna 586 aiv-1 inficirebuli orsuli,
romelTagan 260 imyofeboda 18 Tvian, xolo 326 moklevadian
mkurnalobaze. aseve Catarda 454 bavSvis serologiuri aiv-1 testireba 18
Tvis asakS. MTCT pirvel jgufSi iyo 0%, xolo meoreSi 4.6 % (P<P0.01).
garda amisa, 8 bavSvi 18 Tvian jgufSi da 30 moklevadianSi iyo ZuZuTi
kvebaze da mxolod moklevadiani mkurnalobis jgufis sami bavSvi iyo aiv
dadebiTi. es yovelive mowmobs, rom dedis maRalaqtiuri arv mkurnaloba
mniSvnelovnad amcirebs bavSvis inficirebis risks ZuZuTi kvebis
SenarCunebis drosac ki [22].
sub-saharuli afrikis qveynebidan nigeriaze modis Sidsis
SemTxvevebis 10%, Sesabamisad am qveyanaSi Catarebulia bevri
epidemiologiuri kvleva. erT-erTma maTganma Seiswavla aiv inficirebuli
dedidan bavSvze gadacemis da prevencis codna. gamokiTxul iqna
klinikaSi pirvelad antenatalur vizitze sakonsultaciod myofi 164
deda. aRsaniSnavia, rom maTi codna aiv infeqciis Sesaxeb iyo TiTqmis
100%, vertikaluri gadacemis Sesaxeb - 91%, dedebis 41%-ma gadacemis
yvelaze xSir gzad daasaxela transplacentaruli. miuxedavad amisa,
gamokvleuli qalebis TiTqmis naxevarma ar icoda infeqciis dedidan
bavSvze gadacemis Tavidan acilebis arcerTi meTodi. Sesabamisad
avtorebma daaskvnes, rom dedebis specifiuri codna prevenciuli
RonisZiebebis Sesaxeb jer kidev dabalia da saWiroa am mxriv ufro meti
saganmanaTleblo muSaoba [23].
msgavsi aRwerilobiTi kvleva Catarda samxreT afrikis respublikaSi,
sadac Seiswavles perinataluri gadacemis codna orsul qalebSi. SeirCa
16
erT-erT municipalur klinikaSi antenatalur vizitze myofi 100 orsuli
qali. gamokiTxvam daafiqsira, rom aiv infeqciis Sesaxeb codnis maRali
donis miuxedavad, respodentTa umravlesobaSi dedidan bavSvze gadacemis
codna jer kidev dabalia. kvlevis daskvnebis safuZvelze SemuSavda
jandacvis saganmanaTleblo programebi dedaTa da bavSvTa aiv prevenciis
sferoSi [24].
ekvadorSi Catarebulma aseve jvaredin-seqciurma kvlevam orsuli
qalebis vertikaluri gadacemis codnisa da prevenciis Sesaxeb aCvena,
rom 18 wels zemoT orsuli qalebi, romlebic aRiqvamen dedidan bavSvze
gadacemis risks, 1.74-jer metad mimarTaven (itareben) testirebas (P=.021)
im qalebTan SedarebiT, romlebSic riskis aRqma dabalia. damatebiTi
monacemebi mowmobs, rom eqimis rekomendaciam SesaZloa gazardos qalTa
testireba daaxloebiT 94.3%-mde, da rom, prenataluri mzrunvelobis
klinikebSi unda dainergos saganmanaTleblo RonisZiebebi piradi riskis
aRqmis da testirebis gazrdis mizniT [25].
2008 wlis oqtombridan 2009 wlis ianvramde kamerunSi Catarebulma
jvaredin-seqciurma kvlevam orsuli qalebis dedidan bavSvis inficirebis
codnis Sesaxeb aseve gaamyara azri imis Taobaze, rom prevenciis Sesaxeb
met-naklebad kargi codnis miuxedavad, qalTa formaluri ganaTlebis
gazrdam SesaZloa kidev ufro Seamciros dedidan bavSvze virusis
transmisia. 15-42 wlamde asakis 260 qalidan 80.5%, 89.3% da 81.2% orsuli
Tvlis, rom vertikaluri gadacema SesaZlebelia Sesabamisad
orsulobis, mSobiarobis da ZuZuTi kvebis dros. umaRlesi ganaTlebis
mqone gamokiTxuli qalebis 79% aiv infeqcias Tvlis gadamdebad,
gansxvavebiT 45.5% qalebisa, romelTac ara aqvT umaRlesi ganaTleba
(P=.008) [26].
3.2.2 aziaSi Catarebuli kvlevebi
17
Sri-lanka-Si 2008-2009 wlebSi Catarda aseve jvaredin-seqciuri
kvleva, 400 axal antenatalur dedas Soris vertikaluri gadacemisa da
prevenciis codnis Sesaxeb. respodentTa 97.5 %-s smenia aiv infeqciis
Seesaxeb, 50%-ma icis, rom aiv inficirebuli qalis orsuloba dasaSvebia,
26.3%-ma ar icis amis Sesaxeb, xolo 18.8%-ma ar upasuxa. 88.3%-ma icis, rom
virusi gadadis dedidan bavSvze, 1.5% ki Tvlis, rom ar gadadis, 10.3%-ma
ar upasuxa. gamokiTxuli dedebis 55.8%-ma icis, rom virusi gadaecema
antenatalurad, 10%-is azriT mSobiarobisas da mxolod 5.5 % Tvlis,
rom SesaZlebelia dainficireba ZuZuTi kvebisas. sakvlev pirTa 46.5 %
miiCnevs, rom dedidan bavSvze gadacema arapreventirebadia, 14.3 %-ki
Tvlis, rom prevencia SesaZlebelia. 6%-ma icis rom is Semcirebulia
dedis mkurnalobis Sedegad, da damatebiT 2.5% aRniSnavs, rom
inficirebis Tavidan acileba SesaZlebelia ZuZuTi kvebisgan Tavis
Sekavebisas. qalTa 1.7% -is azriT sakeisro kveTa amcirebs gadacemis
risks. kvlevam aCvena statistikurad mniSvnelovani asociacia dedis
ganaTlebis donesa da MTCT-s da dedidan bavSvze gadacemis prevenciis
(PMTCT) codnis dones Soris [27].H
hong-kongSi gamoikvlies orsuli qalebis aiv codna, riskis aRqma,
sarisko qceva da aseve maTi damokidebuleba aiv skriningis Sesaxeb.
Sedegebma aCvena, rom gamokvleul qalTa codna zogadad Sidsis Sesaxeb
sakmaod maRalia, Tumca isini naklebad gaTviTcnobierebulni arian
dedidan bavSvze aiv gadacemis sakiTxSi. statistikurad sarwmuno
(P<0.001) sxvaoba gamovlinda zogadi ganaTlebis donis mixedviT da hong-
kongSi dabadebulebsa da emigrantebSi CineTis sxva provinciebidan.
gamokiTxul qalTa 36.7% aRiqvamda inficirebis risks da 70% mzad iyo
riskis SemTxvevaSi Caetarebina testireba meuRlesTan erTad. garda amisa,
dadebiTi pasuxis SemTxvevaSi 24% apirebda orsulobis Sewyvetas da
78.5% Tvlida, rom saWiroa aiv skriningis Catareba qorwinebamde da
orsulobisas. es mniSvnelovani gzavnili iyoAjandacvis politikis
SemqmnelebisTvis, raTa SeimuSaon iseTi saganmanaTleblo politika,
18
romelSic gaTvaliswinebuli iqneba yvela riskis jgufi, zogadi
ganaTlebis dabali done da is qalebi, romlebic arian sxvadasxva
provinciebidan, da Sesabamisad gamoiyenon qorwinebamde da orsulobamde
aiv skriningis SesaZlebloba [28].
3.3 aRmosavleT evropis regionSi Catarebuli kvlevebi
CvenTvis saintereso iyo regionSi, kerZod ukrainaSi da ruseTSi,
rogorc რეგიონში yvelaze maRali prevalentobis qveynebSi, Catarebuli
kvelevebi. 2009 wlis kvlevis monacemebiT axlad registrirebul aiv
inficirebulTa Soris qalTa პროცენტულმა წილმა 1995 wlidan 2006
wlamde moimata 13.0%-dan 44.0%-mde ruseTSi da 37.2%-dan 41.9%-mde
ukrainaSi. Sesabamisad gaizarda MTCT-ic da axlad dainficirebulTa
Soris bavSvTa პროპორციამ moimata 2.2%-da 17.6%-mde. inficirebul qalTa
ricxvis didi zrda SeiniSneba orive qveyanaSi. kvlevis Sedegebidan
gamomdinare ikveTeba zogadad qalebis da maT Soris reproduqciuli
asakis qalTa roli infeqciis gavrcelebaSi. mis Tavidan asacileblad ki
aucilebelia specialuri politikis da prevenciuli zomebis SemuSaveba
qalebSi aiv Sesaxeb codnis donis asamaRleblad [29].
msgavsma kvlevam, romelic swavlobda PMTCT programis danergvis
pirvel 2 wels ukrainaSi, aCvena, rom aqtiuri prevenciuli Carevis
Sedegad qalebis daaxleobiT 97% daTanxmda testirebas da 91%-s
Cautarda arv mkurnaloba, Sesabamisad MTCT sixSirem daiklo 30%-dan
(2000 weli) 10%-mde (2002 weli) [30]. ruseTSi 2004-2008 wlebSi Catarebuli
kvlevis monacemebiT, ineqciuri narkomaniis Semcireba da aiv
inficirebul mSobiare qalTa klinikuri momsaxurebis gazrda
mniSvnelovnad asocirebulia perinataluri aiv gadacemis SemcirebasTan,
romelic ufro metad SeiZleba Semcirdes orsulobamde da orsulobis
periodSi testirebis gazrdiT [31]. ukrainaSi, rogorc aiv infeqciis
19
aRmosavleT evropis epicentrSi, Sefasebuli iqna 8 wliani PMTCT-is
efeqturoba. am mizniT kvlevaSi CaerTo 3,356 qali, romelTagan 689 iyo
yofili an mimdinare ineqciuri narkomani. Sedegebma aCvena arsebiTi
gaumjobeseba prevenciuli Carevebis gamoyenebaSi ukrainaSi aiv
inficirebuli orsuli qalebis adreuli diagnostirebiT da arv
profilaqtikis farTo mocviT, ris Sedegadac dedidan bavSvze gadacema
praqtikulad ganaxevრda. ყovelive ეს mianiSnebs e.w “Znelad misaRwev”
populaciaze droulad gasvlis da MTCT-is Semcirebis dakarguli
SesaZleblobebis gazrdis aucileblobaზე [32].
3.4 kvlevebi saqarTveloSi
saqarTveloSi Catarebuli kvlevebis umravlesobis mizani 2005 wels
dawyebuli PMTCT programis Sefaseba iyo, romelsac 116 nebayoflobiTi
konsultaciis da testirebis centri axorcielebs. am programis
farglebSi yvela pirvelad antenatalur vizitze myof qals sTavazoben
nebayoflobiT aiv konsultacias da testirebas, romelic emyareba
skrining meTodiT AntiHIV antisxeulebis aRmoCenas. dadebiTi Sedegebi
igzavneboda Sidsis, xolo 2011 wlidan daavadebaTa kontrolis erovnul
centrSi Semdgomi dadasturebisTvis (Western Blot assay). erT-erTma kvlevam
Seafasa 2000-2005 wlebSi saqarTveloSi elisabed gleizeris pediatriuli
Sidsis fondis mier warmoebuli PMTCT–is muSaoba, da Sedegad
gamovlinda, rom Tbilisis 34 klinikaSi, proeqtSi CarTuli 35,385
orsuli qalidan 91% -s gaewia konsultireba, xolo maTgan 94%-s
Cautarda aiv testireba, romelTagan gamovlinda 14 (<0.001%)
inficirebuli. kvlevam daaskvna, rom bolo wlebSi sqarTveloSi
prevenciuli RonisZiebis wyalobiT Semcirda dedidan bavSvze gadacemis
riski, da arcerT qalSi, romelmac miiRo arv saprofilaqtiko
mkurnaloba, ar moxda aiv infeqciis bavSvze gadacema [33].
20
qarTvel qalebSi dedidan bavSvze aiv infeqciis gadacemis da misi
prevenciis codnis Sesafaseblad kiTxvebi daisva reproduqciuli
kvlevisas, romelic Catarda seriulad 1999, 2005 da 2010 wlebSi
saqarTveloSi. reproduqciuli janmrTelobis kvlevebi (rjk) tardeba
aSS daavadebaTa kontrolis centris (CDC-is) koordinirebiT, im mizniT,
rom moxdes dedaTa da bavSvTa, reproduqciuli da zogadad
janmrTelobis indikatorebis Sesaxeb monacemTa Segroveba da jandacvis
sxvadasxva programebis Sefaseba. misi Catareba daemTxva saqarTveloSi
qalTa janmrTelobis erovnuli politikis SemuSavebas, amdenad msgavsad
sxva rjk-sa es ukanasknelic miznad isaxavda gamoevlina qarTvel qalTa
reproduqciuli da demografiuli maCveneblebi regionul da
subregionul doneze da moexdina misi Sefaseba dinamikaSi [34].
4. kvlevis mizani da amocanebi
Cveni kvleva warmoadgens meorad monacemTa analizs, romelic
eyrdnoba saqarTveloSi 2010 wels Catarebuli reproduqciuli kvlevis
monacemebs.
4.1 kvlevis mizani
kvlevis mizans warmoadgenda saqarTveloSi mcxovrebi
reproduqciuli asakis qalTa aiv infeqciis dedidan bavSvze gadacemis
codnis donis Sefaseba.
4.2 kvlevis amocanebi
1. saqarTveloSi mcxovrebi qalebis dedidan bavSvze aiv infeqciis
gadacemis codnis donis Sefaseba.
21
2. dedidan bavSvze aivinfeqciis gadacemis codnis donesTan
asocirebuli faqtorebis gamovlena.
3. dedidan bavSvze infeqciis gadacemis Sesaxeb codnis donis
asamaRleblad rekomendaciebis SemuSaveba.
5. kvlevis meTodologia
5.1 SerCevis zoma da kvlevis adgili
rogorc aRvniSneT, Cveni kvleva warmoadgens meorad monacemTa
analizs, romelic eyrdnoba saqarTveloSi 2010 wels Catarebuli
reproduqciuli kvlevis monacemebs, romlis meTodologiac detalurad
aris arwerili Sesabamis angariSSi [34]. kvleva Catarda saqarTveloSi da
ukeTesi regionuli da subregionuli Sefasebis misaRebad SerCeva moxda
mravalsafexuriani stratificirebis meTodiT. administraciuli
regionebis Sesabamisad SerCevaSi monawileobda saqarTvelos 11 regioni,
afxazeTis da samxreT oseTis garda. wina kvlevebis msgavsad, 2010 wlis
kvlevac iyo populaciaze dafuZnebuli, saidanac Seiqmna 13,363 komliani
reprezentabeluri nimuSi, romlidanac saboolood SeirCa 6292 qali, maT
Soris kvlevaSi monawileobis maCvenebelma Seadgina 99%.
5.2 kvlevaSi CarTvis procedurebi
kvlevaSi monawileobda TiTo komlidan TiTo qali. Tu komlSi
cxovrobda erTze meti reproduqciuli asakis qali, maSin respodenti
irCeoda randomulad. interviu tardeboda pirispir, saxlSi, sadac isini
cxovrobdnen,Ggamocdili orenovani (bilingvaluri) interviuerebis mier.
5.3 kvlevis instrumenti
22
kvlevis instrumenti iyo kiTxvari. Ggamoyenebul iqna ZiriTadad ori
tipis kiTxvari: kiTxvari komlisTvis da kiTxvari respodentisTvis.
Oorive maTgani Sedgenili iyo qarTul da rusul enaze, pirveli exeboda
ZiriTadad socio-ekonomikur sakiTxebs da komlis wevrTa ganaTlebas,
xolo qalTa kiTxvari ki Sedgenili iyo Semdegi informaciis
mosapoveblad:
demografiuli maCveneblebi
fertiloba da bavSvTa sikvdiloba
ojaxis dadgegma da reproduqciuli SeRavaTebi
reproduqciuli da bavSvTa movlis momsaxurebis gamoyeneba
dedaTa da bavSvTa zrunvis momsaxurebis diapazoni da xarisxi
jandacvis prevenciuli da samkurnalo momsaxurebis gamoyeneba
reproduqciuli jandacvis danaxarjebi
jandacvis servisebis xarisxis aRqma
sarisko qceva (mweveloba da alkoholis moxmareba)
axalgazrdebis janmrTelobis შესახებ ganaTleba da qceva
intimur partniorTa Zaladoba
aiv/Sidsi da sxva sggd
5.4 SerCevis kriteriumebi
15-44 wlamde reproduqciuli asakis qali
kvlevis Catarebis momentSi cxovrobs saqarTveloSi
qarTuli an/da rusuli enis codna (SeeZlos saubari)
Tanaxmaa gasces informirebuli Tanxmoba
Tanaxmaa Seavsos kiTxvari
Tanaxmaa misces interviu
23
6. cvladebi
6.1 ZiriTadi gamosavali cvladi
kvlevis ZiriTad gamosaval cvladad infeqciis vertikaluri
gadacemis Sesaxeb namdvili “mwiri” codna CavTvaleT. (Really poor knowledge).
am ukanasknelis gansazRvra moxda Semdegnairad: SerCeuli 6292 qalidan
kiTxvaze “gsmeniaT Tu ara aiv/Sidsis Sesaxeb?” 6063 respodentma upasuxa
“diax”, 229-m ki “ara”.Qqalebs, romelTac gagonili qondaT aiv infeqciis
Sesaxeb, dausves SekiTxva “SeiZleba აივ-is dedidan bavSvze gadacema A)
orsulobis? B) mSobiarobis? C) ZuZuTi kvebisas?
im SemTxvevaSi, Tu qalma aRniSnul kiTxvaze, upasuxa A”ara” da “ar
vici” orive kiTxvaze (A da B), CavTvaleT “მწირ ” codnad xolo pasuxi
“diax” oriveze - “karg”codnad [cxrili #2].
6.2 prediqtori cvladebi
prediqtor cvladebad CavTvaleT yvela is faqtori, romlebic
SesaZloa kavSirSi iyos virusis dedidan bavSvze gadacemis codnasTan:
qalis asaki, sacxovrebeli adgilis tipi (qalaqad Tu soflad), regioni,
ganaTleba da cocxal bavSvTa raodenoba. Sesabamisad gamovikvlieT,
rogoria asociacia am prediqtor da gamosaval cvladebs Soris.
7. statistikuri analizi da Sedegebi
kvlevis Cveni komponentis damuSaveba moxda statistikur programa
Stata/SEversia12.0-Si. pirvel etapze CavatareT monacemTa aRwerilobiTi,
24
univariaciuli statistikuri, xolo Semdeg bivariaciuli da
multivariaciuli, kerZod poisson regression analizi.
zogadad medicinaSi da sazogadoebriv jandacvaSi sakmaod matulobs
kvlevebi xSiri gamosavaliT (commom outcomes). maT Sorisaa kvlevebi
iSviaTi daavadebebis Sesaxeb, romelTa incidentobac maRali riskis
populaciaSi SeiZleba iyos 10%-ze meti. xSirad mkvlevarebi aseT dros
arasworad iyeneben Logistic-regression analizs, xdeba Odds Ratio-s gamoTvla
misi Semdgomi interpretaciiT rogorc RR, sinamdvileSi ki OR arsebiTad
aWarbebs RR-s, rasac mivyavarT araswor Sedegebamde. aseTi midgoma sworea
rodesac gamosavlis incidentoba aris 10%-ze naklebi. Cveni kvlevis
SemTxvevaSi kiMRR-is da misi sarwmunoebis intervalebis Sesafaseblad
ufro zust Sedegebs iZleva Poisson-regression analizis gamoyeneba,
radganac gamosavali da prediqtori cvladebis mniSvnelobebi aRemateba
10%-s [35].
7.1 aRwerilobiTi statistika (univariaciuli analizi)
7.1.1 demografiuli maxasiaTeblebi
gamokiTxul qalTa 87% iyo qarTveli, 5-5% azerbaijanelebi da
somxebi, xolo 3% yvela sxva erovnebebi. sakvlevi pirebi SerCeulni
iyvnen asakis mixedviT da geografiuli principiT yvela
regionidan.DZiriTadi asaki iyo 15-44 weli, 37.49% iyo 25-dan 34 wlamde
asakis [cxrili #1].
SerCeva moxda ojaxuri statusis miuxedavad. respodentTa
umravlesoba (65.13%) iyo daojaxebuli, maTgan 63.75% imyofeboda kanonier,
xolo 1.38% arakanonier qorwinebaSi. kanonieri qorwinebis maCvenebeli
maRali iyo soflad (63%), vidre TbilisSi (52%) an sxva urbanul
25
dasaxlebaSi (57%). gamokiTxul qalTa 6.18% adre iyo daqorwinebuli,
28.69% ki saerTod ar yofila qorwinebaSi [cxrili #1].
demografiuli maxasiaTeblebidan saintereso iyo maTi ganaTlebis da
dasaqmebis maCveneblebi. respodenti qalebis 21.14%-ma aRniSna saSualoze
dabali ganaTleba, Tbilisel respodentebs Soris 3-jer metad iyvnen
umaRlesi ganaTlebiT, vidre soflad mcxovreblebs Soris. gamokiTxul
qalTa mxolod 22%-ma aRniSna, rom dasaqmebulia ojaxis gareT, rac
TbilisSi da sxva urbanul regionSi gacilebiT MmaRalia (32% da 27%),
vidre soflad (14%). regionebSi gamokiTxul qalTa 86.7%-ma aRniSna, rom
ar muSaobs samuSaos ar qonis gamo [cxrili #1].
repodentebis 85.11% gaxldaT marTlmadidebeli qristiani, maT Soris
84.19% qarTveli. sakvlevi pirebis 8.33% iyo muslimi, 4.43% somexi
grigorianeli xolo danarCeni sxva religiuri konfesiis
warmomadgeneliK[cxrili #1].
7.1.2 reproduqciuli maxasiaTeblebi
kvlevam daafiqsira Sobadobis maRali maCvenebeli (2.0 bavSvi erT
qalze). 2005 wlis kvlevasTan SedarebiT Semcirda xelovnuri abortebis
ricxvi da Seadgina 1.6 erT qalze. aseve sainteresoa xelovnuri
abortebis da cocxladSobadobis Tanafardobis Semcireba, am
ukanasknelis momatebis da pirvelis Semcirebis xarjze. gamokvleuli
qalebis 96%-s gagonili aqvs romelime Tanamedrove kontraceptiuli
saSualebis Sesaxeb, magram sagrZnoblad gansxvavdeba maTi moxmarebis
codna. kvlevam daaafiqsira, rom perinataluri zrunvis momsaxureba
miiRo yvela qalma. orsulebis 98%-s hqonda erTi perinataluri viziti
mainc, qalaqad macxovreblebSi aman 95%-i Seadgena, xolo soflad 86%.
vizitebis umravlesoba Catarda orsulobis pirvel trimestrSi (qalaqad
93%, sofelSi 86%, TbilisSi 94%) [cxrili #1].
26
movaxdineT qalTa ganawileba sam ZiriTad asakobriv jgufad: 15-24,
25-34, da 35-44. garda amisa, dajgufeba moxda sacxovrebeli adgilis
mixedviT, risTvisac 11 ZiriTadi regionis dajgufeba moxda samad,
kerZod, Tbilisis, sxva urbanuli nawilis da soflad mcxovreblebad.
rogorc cxrili #3-dan Cans, respodentTa umravlesoba (37.49%) iyo 25-34
wlamde asakis, 52.72% cxovrobda soflad, xolo danarCeni 47.28%
qalaqad, amaTgan 22.66% TbilisSi da 24.62% sxva urbanul nawilSi
[cxrili#4].
ganaTlebis mxriv, aseve gamoyofili iyo oTxi jgufi: arasruli
saSualo da naklebi, sruli saSualo, teqnikumis da umaRlesi
ganaTlebiT. sakvlevi pirebis 21.14% aRniSna, rom miRebuli aqvs
arasruli saSualo, xolo maT did nawils, kerZod 39.59%-s aqvs
umaRlesi ganaTleba [cxrili #1]. sagulisxmoa, rom sauniversiteto
ganaTlebiT yvelaze metad gamoirCeoda 25-34 wlamde asakis qalebis
jgufi (45.70%), xolo ganaTlebis dabali done aRiniSna 15-24 wlamde
qalebSi (33.21%) [cxrili #4].
rac Seexeba cocxal bavSvTa raodenobas, intervius momentSi
respodentTa 36.17%-s ar yavda bavSvi. es maCvenebeli yvelaze MmaRali iyo
TbilisSi (41.51%) da yvelaze dabali soflad (33.86%) [cxrili #4]. am
cvladis mixedviT qalebi davajgufeT or nawilad, qalebi Tundac erTi
bavSviT (63.83%) da romelTac bavSvi ar yavdaT (36.17%) [cxrili #1]. 15-24
wlamde asakis qalTa 70.36%-s gamokiTxvis procesSi ar yavda arcerTi
bavSvi, xolo bavSvis yolis yvelaze maRali maCvenebeli dafiqsirda 35-44
wlis asakis qalebSi (83.68 %-) [cxrili #4]. sacxovrebeli adgilis
mixedviT ki igive maCvenebeli maRali iyo soflad macxovreblebSi (66.14
%), xolo yvelaze dabali urbanul, gansakuTrebiT ki Tbilisis
mcxovreblebSi (41.51 %) [cxrili #4]. ganaTlebis mixedviT procentulad
yvelaze meti, erTze meti bavSvi, yavda teqnikuri ganaTlebis mqone
qalebs (73.64%), xolo uSvilobis yvelaze maRali Sedegi gamovlinda
arasruli saSualo ganaTlebis qalTa 45.79 %-s [cxrili#4].
27
7.2 bivariaciuli analizi
bivariaciuli analiziT gamovavlineT gamosavali da prediqtori
cvladebis asociacia. gamoviangariSeT riskTa Tanafardoba (Relative Risk),
95% sarwmunoebis intervaliT da P-value. Yyvela prediqtor cvladTan
mimarTebaSi referens anu Sesadarebel jgufad aviReT dedidan bavSvze
gadacemis codnis mxriv maRalmaCvenebliani jgufebi, kerZod, asakTan
dakavSirebiT 35-44 wlamde qalTa kontingenti, ganaTlebis mxriv
umaRlesi, sauniversiteto ganaTlebis mqone respodentebi, xolo bavSvTa
raodenobis mixedviT ki qalebi, romelTac yavdaT erTi an erTze meti
bavSvi.
cxrili #3-Si mocemulia codnis donis ganawileba prediqtori
cvladebis (asaki, regioni, ganaTleba da bavSvis raodenoba) mixedviT.
aRniSnuli analizis Sedegad dadginda, rom sacxovrebeli adgili ar
aRmoCnda statistikurad sarwmuno risk faqtori dedidan bavSvze aiv
infeqciis gadacemis codnis donesTan mimarTebaSi (P=0.496). soflad
macxovrebel respodentebSi “mwiri” codna gamoavlina gamokiTxul qalTa
36.3%-ma (#=3121) xolo sxva urbanuli dasaxlebis da Tbilisis
macxovreblebSi igi Sesabamisad iyo 31.6% (#=1520) da 32.8% (#=1422)
[cxrili #3].
rac Seexeba aiv infeqciis dedidan bavSvze gadacemis codnas
askobrivi jgufebis mixedviT, yvelaze “mwiri” codna gamovlinda 15-24
wlamde asakis qalebSi (40.3 %), xolo es maCvenebeli didad ar
gansxvavdeba sxva asakobrivi kategoriis igive maCveneblisgan da Seadgens
32.2% (#=2284) da 30.8% (#=1920) Sesabamisad 25-34 da 35-44 wlis qalebSi
(RR=1.4; CI(1.26-1.57); P<0.01) [cxrili #5].
mniSvnelovani risk faqtori aRmoCnda qalTa zogadi ganaTlebis
done. MTCT “mwiri” codnis yvelaze maRali maCvenebeli aRiniSna
28
arasruli ganaTlebis mqone respodentebSi (42.5 %), Sesabamisad codnis
maRali done gamovlinda umaRlesi ganaTlebis mqone qalebSi 70.6% (RR
=1.53; CI (1.36-1.72); P<0.01) [cxrili #5].
rac Seexeba bavSvebis raodenobas, dedidan bavSvze gadacemis codnis
TvalsazrisiT ufro infomirebulni aRmoCdnen bavSviani qalebi, im
qalebTan SedarebiT, romelTac ar yavdaT arcerTi bavSvi (RR=1.34;
CI(1.23-1.46); P<0.01) [cxrili #5].
7.3 multivariaciuli analizi
bivariaciulma analizma aCvena mniSvnelovani asociacia zogierT
prediqtor cvladsa da ZiriTad gamosaval cvlads Soris. imis
gasarkvevad, Tu romel maTganTan iyo ufro metad sarwmuno asociacia,
kerZod, SesaZlo konfaunderis da efeqt modifikatoris gamosaricxad,
CavatareT multivariaciuli statistikuri analizi. aRwerilobiTi da
bivariaciuli nawilis msgavsad, es analizic Catarda statistikur
programa Stata/SE 12-e versiaSi. CavatareT Poisson regression analizi,
romlebmac aCvena, rom regioni ar aRmoCnda statistikurad sarwmuno
risk faqtori, da rom yvelaze mniSvnelovani prediqtorebi, romlebic
asocirebulia vertikaluri gadacemis codnasTan, asaki da ganaTlebaa
(RR=1.15; P=0.022; CI(1.02-1.29); RR=1.40; P<0.001; CI(1.24-1.59); RR=1.23; P=0.002;
CI(1.08-1.41)). rac Seexeba cocxal bavSvTa raodenobas, is pirdapir
proporciul damokidebulebaSia asakTan. 15-24 wlamde qalebSi
logikurad ufro naklebia bavSvTa raodenoba, vidre 25-34 da 35-44 wlis
asakobriv jgufebSi. Sesabamisad, SegviZlia davaskvnaT, rom rac ufro
mcirea qalis asaki, dabalia zogadi ganaTlebis done da naklebia
Svilebis raodenoba, miT metia “mwiri” codna, anu miT ufro naklebia
dedidan bavSvze aiv virusis gadacemis Sesaxeb codnis done [cxrili #6].
29
Cvens mier ganxiluliPPoisson-regression modelis gantoleba SeiZleba
Semdegi saxiT iqnas warmodgenili:
(“mwiri” codna) = 1.04 (sofelSi cxovreba) – 1.1 (Tbilisis garda sxva
qalaqSi cxovreba) + 1.15 (asaki 15-24) + 1.04 (asaki 25-34) + 1.40 (arasruli
saSualo ganaTleba da naklebi) + 1.23 (sruli saSualo ganaTleba) + 1.07
(teqnikumi) + 1.22 (arcerTi bavSvis yola) [cxrili #5].
8. diskusia
rogorc zemoTaRniSnulidan Cans, prevenciis TvalsazrisisiT
sakmaod mniSvnelovania qalebis codna zogadad aiv infeqciis, sakuTari
inficirebulobis da prevenciuli RonisZiebebis Sesaxeb.
msoflioSi Catarebuli msgavsi kvlevebisas, rodesac sazRvravdnen
dedidan bavSvze virusis gadacemis codnis dones es ukanaskneli
ZiriTadad iyofoda e.w “karg” da “mwir” codnad. sazogadoebrivi
jandacvis TvalsazrisiT, realuri suraTis Sesafaseblad da
samomavlod prevenciuli Carevebis dagegmvis mizniT gacilebiT
mniSvnelovania im adamianTa da konkretul SemTxvevaSi im qalTa
raodenoba romelTa codnis donec dabalia. swored amitom Cvens
SemTxvevaSic gamosaval cvladad “mwiri” codna CavTvaleT.
sxva qveynebisgan gansxvavebiT, saqarTveloSi cotaa Catarebuli
iseTi kvlevebi, romlebic Seiswavlidnen mosaxleobis informirebulobas
aiv infeqciis da masTan dakavSirebuli safrTxeebis Sesaxeb. rogorc
cnobilia, CvenTan mravali welia reproduqciuli programis farglebSi
antenatalur klinikaSi sakonsultaciod misul TiTqmis yvela orsuls
utardeba aiv infeqciaze ufaso konsultacia da testireba. aRniSnulis
miuxedavad, Cveni kvlevis analizidan Cans, rom saqarTveloSi mcxovreb
Svilosnobis asakis qalebSi zogadad infeqciis, dedidan bavSvze misi
gadacemis codnis done aradamakmayofilebelia. 1999 da 2005 wlebSi
30
Catarebuli analogiuri kvlevebis SedegebTan SedarebiT 2010 wels
SeimCneva am mxriv gaumjobesebis tendencia, Tumca respodentTa
umravlesobaSi problemis aRqma da gacnobiereba kvlav araadeqvaturia.
im qalebSi, romelTac yavT erTi da meti bavSvi, dedidan bavSvze aiv
infeqciis prevenciis programebis wyalobiT, vertikaluri gadacemis
Sesaxeb “mwiri” codna iyo SedarebiT naklebad gamoxatuli (31.4%)
uSviloebTan SedarebiT (39.3%), rac, Cvenis azriT, logikuria imis
gaTvaliswinebiT, rom yoveli wina orsulobisas antenatalur klinikaSi
qals miRebuli unda hqondes informacia aiv infeqciis da dedidan
bavSvze misi gadacemis Sesaxeb. es kidev erTxel xazs usvams sakiTxTan
dakavSirebiT eqimebis da zogadad samedicino personalis mniSvnelovan
rolze reproduqciuli asakis qalTa aiv infeqciaze codnis donis
amaRlebaSi. sasurvelia, rom sxvadasxva profilis eqimebma, romelTa
specializaciac met-naklebad kavSirSia aiv infeqciasTan, zogadad
infeqciur daavadebebTan, aseve sggd-Tan (zogadi praqtikis eqimebi,
ojaxis eqimebi, mean-ginekologebi, infeqcionistebi, venerolog-
dermatologebi, pediatrebi), ar daiviwyon qali pacientebis vizitis
dros mokle informaciis miwodeba aiv vertikaluri gadacemis Sesaxebac.
Cveni analizidan Cans, rom dedidan bavSvze aiv gadacemis codna
mniSvnelovnad matulobs asakTan da zogadi ganaTlebis donesTan erTad.
igi gacilebiT maRalia teqnikumis da umaRlesi ganaTlebis da aseve 25-34
da 35-44 wlis asakis qalebSi, 15-24 wlis saSualo ganaTlebis mqone
respodentebTan SedarebiT. warsulSi Catarebul kvlevebis SedegebTan
SedarebiT metnaklebi gaumjobesebis miuxedavad, Cvens mier Catarebulma
kvlevam gviCvena, rom aiv-is gadacemis, prevenciis da sarisko qcevis
Sesaxeb codnis done saqarTvelos reproduqciuli asakis qalebSi kvlav
dabalia.
9. kvlevis susti da Zlieri mxareebi
31
rogorc yvela kvlevis dros, Cvens SemTxvevaSic adgili hqonda
naklovanebebs. Cvenis azriT, mniSvnelovani SezRudva iyo is, rom kvleva
Catarda samuSao saaTebSi, rac imas niSnavs, rom respodentebi umravles
SemTxvevaSi iyvnen mxolod diasaxlisebi. SesaZloa aman gavlena iqonia
kvlevis Sedegebze, radganac gamoricxuli ar aris, rom qalebs,
romlebic muSaoben da romelTac ar miuRiaT monawileoba, gacilebiT
meti codna gaaCniaT aRniSnul problemasTan dakavSirebiT. garda amisa
naklovanebad SeZleba CaiTvalos is faqti rom kvleva eyrdnoboda
mxolod respodentebis mier mowodebul informacias, rac ar
gamoricxavs informaciuli, kerZod ki gaxsenebis cdomilebas (information,
recall bias).
Zlieri mxareebidan aRsaniSnavia nimuSis zoma, romelic, Cvenis
azriT, adeqvaturia da sakmarisia statistikurad sarwmuno Sedegebis
misaRebad da aseve TiToeuli komlidan, sadac erTze meti qali
cxovrobda, respodentTa randomuli SerCeva, rac gamoricxavs SerCevis
cdomilebas (selection bias).
10. daskvna da rekomendaciebi
Cvens mier Catarebuli kvleva mniSvnelovan informacias gvaZlevs
saqarTveloSi mcxovreb reproduqciuli asakis qalTa Soris zogadad aiv
infeqciis da dedidan bavSvze misi gadacemis Sesaxeb codnaze. analizis
safuZvelze SeiZleba davaskvnaT, rom es codna jer kidev
aradamakmayofilebelia da CvenTan mimdinare prevenciuli da
saganmanaTleblo programebis miuxedavad, am mxriv gasakeTebeli kidev
bevria. imis gaTvaliswinebiT, rom Svilosnobis asakis qalebi prevenciis
TvalsazrisiT mniSvnelovani rgolia, maTi informireba, konsultireba,
testireba da Sesabamisad aiv infeqciis adreuli diagnostika da
saWiroebis SemTxvevaSi arv mkurnalobis drouli dawyeba efeqturi
32
prevenciuli meTodi iqneba, ris warmatebiT ganxorcielebaSic ki
gadamwyveti roli samedicino dawesebulebebis personals miuZRvis.
Sesabamisad, medpersonalisTvis xSirad Sexseneba aiv infeqciaze
konsultirebis mniSvnelobis Sesaxeb (gansakuTrebiT ki orsulebSi)
savaraudod, gazrdis maT mier pacientebisTvis informaciis miwodebis
efeqturobas, rac pacintebis informirebulobis da saboloo jamSi,
orsulTa aiv infeqciaze testirebis mocvas gazrdis. es ki, Sesabamisad,
inficirebul orsulTa drouli gamovlenis da prevenciuli mkurnalobis
dawyebis safuZveli iqneba.
33
cxrili #1. Ddemografiuli da reproduqciuli maxasiaTeblebi
maxasiaTebeli raodenoba procentuli maCvenebeli# %
1. asaki
15-24 1,960 31.15
25-34 2,359 37.49
35-44 1,973 31.36
2. erovneba
qarTveli 5,488 87.22
azeri 276 4.39
somexi 364 5.79
sxva 164 2.61
3. qorwineba
qorwinebaSi myofi 4,098 65.13
adre daqorwinebuli 389 6.18
qorwinebaSi armyofi 1,805 28.69
4. muSaobT Tu ara amJamad
saxlSi 4,940 78
saxlsgareT 1,352 22
5. religia
marTlmadidebeliqristiani
5,35585.11
muslimi 524 8.33
grigorianeli 279 4.43sxva
1342.13
34
6. bavSvebis raodenoba
0 2,276 36.17
1 1,286 20.44
2 2,069 32.88
3 539 8.57
4+ 122 1.94
7. ganaTleba
arasruli saSualo danaklebi
1,33021.14
sruli saSualo 1,568 24.92
teqnikumi 903 14.35
universiteti 2,491 39.59
8. gaugia kontraceptivebis Sesaxeb
diax 6,006 95.45
ara 286 4.55
8. regioni
Tbilisi 1,426 22.66
sxva urbanuli 1,549
sofeli 3,317 52.72
35
cxrili #2. aiv infeqciis Sesaxeb informirebuloba
raodenoba
procentuli
maCvenebeli
# %
gsmeniaT Tu ara aiv/Sidsis
Sesaxeb?
diax 6,063 96.36
ara 229 3.64
SesaZlebelia aiv virusis dedidan
bavSvze gadacema
orsulobisas da
mSobiarobisas?
diax 3,985 65.73
ara/ar vici 2,078 34.27
36
cxrili #3. დედიდან ბავშვზე აივ ინფექციის გადაცემის ცოდნის ასოციაცია
დემოგრაფიულ და რეპროდუქციულ ფაქტორებთან
dedidan bavSvze aiv gadacemis
codna
(orsulobas+mSobiaroba)
“kargi”
codna
“mwiri”
codna sul
# % # % # %
3,985 65.7 2,078 34.3 6,063 100
regioni
Tbilisi 956 67.2 466 32.8 1,422
sxva urbanuli 1,040 68.4 480 31.6 1,520
sofeli 1,989 63.7 1,132 36.3 3,121
asaki
15-24 1,109 59.7 750 40.3 1,859
25-34 1,548 67.8 736 32.2 2,284
35-44 1,328 69.2 592 30.8 1,920
ganaTleba
arasruli saS.da < 680 57.5 502 42.5 1,182
sruli saSualo 950 62.8 563 37.2 1,513
teqnikumi 608 68.1 285 31.9 893
universiteti 1,747 70.6 728 29.4 2,475
bavSvis r-ba
0 bavSvi 1,329 60.7 862 39.3 2,191
# bavSvi 2,656 68.6 1216 31.4 3,872
37
cxriliN#4. prediqtor cvladTa urTierTdamokidebuleba
regioni* ganaTleba***bavSvis#****
1 2 3 0 1 2 3 0 1
% % %asaki**15-24(1) 23.01 24.8 52.19 33.21 30.82 8.42 27.55 70.36 29.6425-34(2) 22.85 23.82 53.33 15.64 25.39 13.27 45.7 24.37 75.6335-44(3) 22.1 25.39 52.51 15.71 18.5 21.54 44.25 16.32 83.68
regioniTbilisi(1) 10.38 16.13 10.38 63.11 41.51 58.49sxva urbanuli(2) 15.43 21.69 14.49 48.29 36.22 63.78sofeli(3) 28.43 30.21 15.95 25.41 33.86 66.14
ganaTlebaarasrulisaS.< 45.79 54.21saSualo (1) 32.27 67.73teqnikuri (2) 26.36 73.64umaRlesi (3) 37.05 62.95
*:1-Tbilisi, 2-sxva urbanuli, 3-sofeli;
**: 1-(15-24), 2-(25-34), 3-(35-44);
***: 0- arasruli saSualo ganaTleba da naklebi, 1-sruli saSualo, 2-teqnikumi, 3-universiteti;
****: 0-arcerTi bavSvi, 1-nebismieri #bavSvi
38
cxrili #5. bivariaciuli analizi
"kargi"
codna
"mwiri"
codna RR CI 95%
P
value# % # %
sul 3,985 65.73 2,078 34.27
regioni
Tbilisi 956 67.23 466 32.77
sxva
urbanuli 1,040 68.42 480 31.58 0.96 0.87_1.07 0.496
sofeli 1,989 63.73 1,132 36.27 1.11 1.01-1.21 0.024
asaki
15-24 1,109 59.66 750 40.34 1.4 1.26-1.57 <0.01
25-34 1,548 67.78 736 32.22 1.06 0.95-1.19
35-44 1,328 69.17 592 30.83 1
ganaTleba
arasruli
saS.< 680 57.53 502 42.47 1.53 1.36-1.72 <0.01
sruli saS. 950 62.79 563 37.21 1.28 1.13-1.46
teqnikumi 608 68.09 285 31.91 1.05 0.90-1.21
universiteti 1,747 70.59 728 29.41 1
bavSvebis r-ba
0 bavSvi 1,329 60.66 862 39.34 1.34 1.23-1.46 <0.01
# bavSvi 2,656 68.6 1,216 31.4 1
39
cxrili #6. multivariaciuli (Survey: Poisson regression) analizi
RR P value CI 95%
regioniTbilisisxva urbanuli 0.90 0.259 0.76-1.08sofeli 1.04 0.579
asaki15-24 1.15 0.022 1.02-1.2925-34 1.04 0.517 0.93-1.1635-44 1
ganaTleba
arasruli saS< 1.40 0.000 1.24-1.59sruli saS. 1.23 0.002 1.08-1.41teqnikumi 1.07 0.418 0.91-1.24Universiteti 1
bavSvebis r-ba0 bavSvi 1.22 0.000 1.11-1.35#bavSvi 1
11. gamoyenebuli literatura:
1. www.who.int/
2. Margaret Chan, Michel Sidibé, Anthony Lake;WHO, UNAIDS, UNICEF, Global
HIV/AIDS Response– “Epidemic update and health sector progress towards Universal
Access – Progress Report 2011”
3. International Federation of Red Cross and Red Crescent Societies.Action with
youth.HIV/AIDS and STD: A training manual for young people, Second edition, 2000.
4. m. buwaSvili, g. kamkamiZe. aiv infeqcia/ Sidsi, Tbilisi 2002.
5. TEARFUND 2008 “Scaling up prevention of Mother-to-Child Transmission of HIV”
40
6. Eli Fjeld Falnes, Thorkild Tylleskär, Marina Manuela de Paoli, Rachel Manongi, Ingunn
MS Engebretsen. “Mothers’ knowledge and utilization of prevention of mother to child
transmission services in northern Tanzania.Falnes et al. Journal of the International AIDS
Society 2010, 13:36.
7.http://www.bio.davidson.edu/people/dawessner/361HIV/podcast/AIDS_Pandemic_20.m4a
mother-to-child-transmission;
8. Gundel Harms, Angelika Mayer and Heiko Karcher.Prevention of Mother-to-Child
Transmission of HIV in Kenya, Tanzania and Uganda”.Published by: Deutsche
Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH. September 2003.
9. Jukes M, Simmons S, Bundy D. Education and vulnerability: the role of schools in
protecting young women and girls from HIV in southern Africa. AIDS. 2008 Dec;22
Suppl 4:S41-56.
10. www.who.html Key facts on HIV epidemic and progress in regions and countries in
2010. Based on Progress report 2011: Global HIV/AIDS response.North America,
Western and Central Europe.
11. Epidemiological Fact Sheet on HIV and AIDS, 2009HIV And AIDS Estimates
(2009)United States of America
12. Jane McCall, RN, MSN,Laura Vicol, NP(F), MN Gloria Tsang, Pbarm, BSC, ACP
Healthy Mothers, Healthy Babies: Preventing Vertical Transmission of HIV/AIDS;”
Hurs'ingbc ; April 2009
13. UNAIDS; Eastern Europe and Central Asia;Global Report;2010
14. www.who.html. Key facts on HIV epidemic and progress in regions and countries in
2010 Based on Progress report 2011: Global HIV/AIDS response Eastern Europe and
Central Asia
15. www.aidscenter.ge/epidsituation-geo.html
41
16. United Nations General Assembly Special Session on HIV/AIDS Monitoring the
Declaration of Commitment on HIV/AIDS; Georgia, Country Progress Report, Reporting
Period 2008 – 2009 calendar years
17. Benjamin P. Linas, MD, Hui Zheng, PhD, Elena Losina, PhD, Rochelle P Walensky.
MD, MPH, and Kenneth A. Freedberg, MD, MS; “Assessing the Impact of Federal HIV
Prevention Spendingon HIV Testing and Awareness “;American Journal of Public Heaith
| June 2006. Vol 96, No. 6
18. Tessa Goetghebuer, Edwige Haelterman, Isabelle Marvillet, Patricia Barlow, Marc
Hainaut, Assaad Salameh, Roberta Ciardelli, Michele Gerard, Jack Levy; “Vertical
transmission of HIV in Belgium: a 1986–2002 retrospective analysis”; Eur J Pediatr
(2009) 168:79–85
19. European Collaborative Study; “Mode of delivery in HIV-infected pregnant women and
prevention of mother-to-child transmission: changing practices in Western Europe; DOI:
10.1111/j.1468-1293.2009.00800.x, HIV Medicine (2010), 11, 368–378.
20. N Agmon-Levin MD, D Elbirt MD, I Asher MD, D Torten MD, Y Cohen BA, S
Gradestein MD, B Werner MD, D Turner MD, M Chowers MD, G Gottesman MD,
SMaayan MD, K Risenberg MD,I Levi MD and Z Sthoeger MD; “Prevention of human
immunodeficiency virus mother-to-child transmission in Israel”; DOI:
10.1258/ijsa.2008.008392. International Journal of STD & AIDS 2009; 20: 473–476.
21. E Visconti MD, Lucia Pastore Celentano MD, Salvatore Marinaci MD, Giancarlo
Scoppettuolo MD and Enrica Tamburrini MD; “Mother to child human immunode®
ciency virus (HIV) transmission: what HIV-infected women think. Our experience in
Rome, Italy”; International Journal of STD & AIDS 2002; 13: 551± 553.
22. Seni Kouandaa, Halima Tougria, Mireille Cisse, Jacques Simpore, Virginio Pietrad,
Boukare´ Doulougoua, Gautier Oue´draogoa, Charlemagne Marie Oue´draogoe, Robert
Soudre´ e and Blaise Sondoa; “Impact of maternal HAART on the prevention of mother-
to-child transmission of HIV: results of an 18-month follow-up study in
Ouagadougou,Burki na Faso”; AIDS Care Vol. 22, No. 7, July 2010, 843850.
42
23. S.I. Adeleke, M. Mukhtar-Yola, G.D Gwarzo; “Awareness and knowledge mother-to-
child transmission of HIV among mothers attending pediatric HIV clinic, Kano, Nigeria”;
Annals of African Medicine, Vol.8, No,4;2009:210-214.
24. MS Maputle, D.Cur, M.Cur, RM, RN; “Pregnant women's knowledge about Mother-to-
Child Transmission (MTCT) ofHIV infection through breast feeding”; Curationis March
2008.
25. J.L. Dearborna, J. Lewisa and G.P. Min˜; “Preventing mother-to-child transmission in
Guayaquil, Ecuador: HIV knowledge and risk perception”; Global Public Health Vol. 5,
No. 6, November 2010, 649662.
26. Anne-Cécile Zoung-Kanyi Bissek, Irène Emah Yakana, Franscisca Monebenimp,
Guillaume Chaby, Linda Akondeng, Samuel A. Angwafor, Catherine Lok, Alfred K.
Njamnshi, and Walinjom F.T. Muna; “Knowledge of Pregnant Women on Mother-to-
Child Transmission of HIV in Yaoundé”; The Open AIDS Journal, 2011, 5, 25-28.
27. H.P. Perera, C. Wickramasooria, K.P.J. Perera, A. Pathmeshwaran; “Knowledge on
mother to child transmission (MTCT) and prevention of mother to child transmission
(PMTCT) of HIV among newly registered antenatal mothers in Medical Officer of Health
(MOH) area in Ragama, Sri Lanka 2008-2009”; ????
28. Choi Fung Ho BSN MSc RN; “HIV/AIDS knowledge and risk behaviour in Hong Kong
Chinese pregnant women”; HO C.F. & LOKE A.Y. (2003) Journal of Advanced Nursing
43(3), 238–24.
29. Burruano L, Kruglov Y; “HIV/AIDS epidemic in Eastern Europe: recent developments in
the Russian Federation and Ukraine among women”; Gend Med. 2009 Apr;6(1):277-89.
30. Malyuta R, Newell ML, Ostergren M, Thorne C, Zhilka N; “Prevention of mother-to-
child transmission of HIV infection: Ukraine experience to date”; Eur J Public Health.
2006 Apr;16(2):123-7. Epub 2006 Feb 13
31. Dmitry M Kissin, Michele G Mandel, Natalia Akatova, Nikolay A Belyakov, Aza G
Rakhmanova, Evgeny E Voronin, Galina V Volkova, Alexey A Yakovlev, Denise J
43
Jamieson, Charles Vitek, Joanna Robinson, William C Miller, and Susan Hillis; “Five-
year trends in epidemiology and prevention of mother-to-child HIV transmission, St.
Petersburg, Russia: results from perinatal HIV surveillance”; BMC Infect Dis. 2011; 11:
292.
32. Claire Thorne, Igor Semenenko, Tatyana Pilipenko, Ruslan Malyuta and the Ukraine
European Collaborative Study Group; “Progress in prevention of mother-to-child
transmission of HIV infection in Ukraine: results from a birth cohort study”; BMC
Infectious Diseases 2009, 9:40 doi:10.1186/1471-2334-9-40.
33. Tsertsvadze T, Kakabadze T, Shermadini K, Abutidze A, Karchava M, Chkhartishvili N,
Badridze N, Bokhua Z, Asatiani T. “Prevention of mother-to-child transmission of HIV:
the Georgian experience “; Cent Eur J Public Health. 2008 Sep; 16(3):128-33.
34. Florina Serbanescu, Vasili Egnatashvili, Alicia Ruiz, Danielle Suchdev, Mary Goodwin;
“Reproductive Health Survey Georgia, 2010; Summary Report”.
35. Louise-Anne McNutt, Chuntao Wu, Xiaonan Xue, and Jean Paul Hafner, “Estimating the
Relative Risk in Cohort Studies and Clinical Trials of Common Outcomes”; Am J
Epidemiol 2003;157:940–943.
44
damateba
kvlevis instrumenti:
kiTxvari reproduqciuli asakis qalTa aiv infeqciis codnis donis
Sesafaseblad
# saidentifikacio nomeri -----------------------
1. asaki -------------- wlis
2.sacxovrebeli adgili qalaqi -------------------------------
sofeli-------------------------------
3.
ojaxuri mdgomareoba daojaxebuli
ganqorwinebuli
ar yofila daojaxebuli
4. BbavSvis raodenoba
0
1
2
3
4+
5.
Tqveni ganaTlebis done
Aarasruli saSualo da naklebi
sruli saSualo
teqnikumi
Uuniversiteti
6. muSaobT Tu ara? Aara
45
ki
7.
103. muSaobT Tu ara
Tqven amJamad ojaxis
gareT, kviraSi 20 saaTi
mainc?
1. diax
2. diax, magram imyofeboda
dekretul SvebulebaSi
3. -ze
1000G gsmeniaT Tu ara
aiv/Sidsis Sesaxeb?
1. Ddiax gadadi k1029
2. ara
8.
1029. SeiZleba Tu ara,
rom Sids-is gamomwvevi
virusi dedisgan Svils
gadaeces Semdeg viTarebaSi
A. orsulobisas?
B. mSobiarobisas?
C. ZuZuTi kvebisas?
1. diax
2. ara
3. ar vici
N