Abrahams Naeemah, Jewkes Rachel, Lombard Carl, Mathews Shanaaz, Campbell Jacquelyn, Meel Banwari
Gender & Health Research Unit, Medical Research Council, Cape Town, South Africa.
AIDS Care. 2010 Oct;22(10):1173-81. doi: 10.1080/09540121003692185.
South Africa has one of the highest rates of both rape and HIV infections. Of great concern is the possibility of HIV transmission during the assault, but adherence to post-exposure prophylaxis (PEP) has been varied and low. We developed a telephonic psycho-social support, leaflet and adherence diary intervention for rape victims and tested its impact on adherence to PEP. A randomised control trial was conducted in the Western and Eastern Cape and 279 rape survivors were enrolled in two arms. The intervention involved the providing of an information leaflet including an adherence diary and follow-up support through telephone calls by a counsellor during the 28 days of taking the PEP. The controls received the leaflet. Follow-up interviews and tablet checks were done with 253 participants to assess adherence. The primary outcome was completion of 28 days of PEP with no more than three missed doses (94% adherence). There was more adherence in the intervention arm (38.2% vs. 31.9%), but the estimated intervention effect of 6.5% (95% CI: -4.6 to 17.6%) was not statistically significant, p=0.13. The intervention was associated with the reading of the pamphlet (p=0.07) and an increased use of the diary (p=0.01), but did not reduce depressive psychopathology. Overall adherence was greater amongst those who read the leaflet and used the medication diary. The study showed that the intervention was not effective in significantly improving adherence and adherence levels were low in both study arms. Further research to understand reasons for non-adherence is needed before further interventions are developed.
南非的强奸率和艾滋病毒感染率均位居世界前列。令人极为担忧的是，在强奸过程中存在艾滋病毒传播的可能性，但接触后预防（PEP）的依从性参差不齐且较低。我们为强奸受害者开发了一种电话心理社会支持、宣传册和依从性日记干预措施，并测试了其对PEP依从性的影响。在西开普省和东开普省进行了一项随机对照试验，279名强奸幸存者被纳入两个组。干预措施包括提供一份信息宣传册，其中包括一本依从性日记，并在服用PEP的28天内由一名咨询师通过电话提供后续支持。对照组仅收到宣传册。对253名参与者进行了随访访谈和药片检查，以评估依从性。主要结局是完成28天的PEP，漏服剂量不超过三次（依从性为94%）。干预组的依从性更高（38.2%对31.9%），但估计的干预效果为6.5%（95%CI：-4.6至17.6%），无统计学意义，p=0.13。该干预措施与宣传册的阅读（p=0.07）和日记使用的增加（p=0.01）相关，但并未减轻抑郁心理病理学症状。总体而言，阅读宣传册并使用药物日记的人的依从性更高。该研究表明，该干预措施在显著提高依从性方面无效，且两个研究组的依从性水平均较低。在开发进一步的干预措施之前，需要进行进一步的研究以了解不依从的原因。
