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

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44

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