Mepham S, Zondi Z, Mbuyazi A, Mkhwanazi N, Newell M L
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
AIDS Care. 2011 Jun;23(6):741-7. doi: 10.1080/09540121.2010.516341.
Women living with HIV in sub-Saharan Africa face significant challenges in accessing HIV care and adhering to antiretroviral therapy. Most reports have focused on issues relating to long-term adherence such as those surrounding stigma and disclosure, hunger, cultural factors, lack of accurate health information, lack of social support, medication side effects and overcrowded health systems. Information related to the challenges facing pregnant women when taking antiretrovirals for prophylactic purposes is limited. The "Kesho Bora Study" is a multicentre prevention of mother-to-child transmission (PMTCT) trial in sub-Saharan Africa evaluating the PMTCT efficacy of triple therapy until cessation of breast feeding compared to short course zidovudine monotherapy in a predominantly breast feeding population. Following unexplained discrepancies during objective adherence assessments, a sub-study was conducted at one site to examine the underlying adherence issues.
The counselling and clinical notes of all 100 enrolled Zulu women were examined. Extracted information was supplemented by unstructured, free-ranging interviews conducted by trained adherence counsellors on 43 consecutive women attending the trial clinic over a two-week period. Adherence was defined as good (>95% adherence), or poor (<95% adherence).
Reasons provided for sub-optimal adherence included therapy misconceptions/misunderstandings, antiretroviral use by relatives, domestic violence, poverty and issues relating to disclosure and stigma. About 61% (57/94) of antenatal women had good adherence with their PMTCT prophylaxis, with no significant difference shown between those taking the long and short course.
Antenatal women in northern rural KwaZulu-Natal face significant challenges in taking antiretroviral PMTCT prophylaxis.
撒哈拉以南非洲地区感染艾滋病毒的女性在获得艾滋病毒治疗及坚持抗逆转录病毒治疗方面面临重大挑战。大多数报告聚焦于与长期坚持治疗相关的问题，如耻辱感与信息披露、饥饿、文化因素、缺乏准确的健康信息、缺乏社会支持、药物副作用以及过度拥挤的医疗系统等。关于孕妇出于预防目的服用抗逆转录病毒药物时所面临挑战的相关信息有限。“Kesho Bora研究”是撒哈拉以南非洲地区一项多中心预防母婴传播（PMTCT）试验，在以母乳喂养为主的人群中，评估三联疗法直至停止母乳喂养与短期齐多夫定单药疗法相比在预防母婴传播方面的疗效。在客观依从性评估期间出现无法解释的差异后，在一个研究点开展了一项子研究，以探究潜在的依从性问题。
对所有100名登记入组的祖鲁族女性的咨询记录和临床记录进行了检查。提取的信息由经过培训的依从性咨询师对连续43名在两周内到试验诊所就诊的女性进行的非结构化、自由式访谈进行补充。依从性被定义为良好（依从率>95%）或不佳（依从率<95%）。
依从性欠佳的原因包括对治疗的误解、亲属使用抗逆转录病毒药物、家庭暴力、贫困以及与信息披露和耻辱感相关的问题。约61%（57/94）的孕妇在预防母婴传播方面依从性良好，服用长疗程和短疗程药物的孕妇之间无显著差异。
夸祖鲁-纳塔尔省北部农村地区的孕妇在服用抗逆转录病毒药物进行预防母婴传播时面临重大挑战。
