Department of International Health, Global Disease Epidemiology and Control Program, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe Street, Suite W5031, Baltimore,MD21205, USA.
AIDS. 2012 Oct 23;26(16):2039-52. doi: 10.1097/QAD.0b013e328359590f.
To estimate antiretroviral therapy (ART) adherence rates during pregnancy and postpartum in high-income, middle-income, and low-income countries.
Systematic review and meta-analysis.
MEDLINE, EMBASE, SCI Web of Science, NLM Gateway, and Google scholar databases were searched. We included all studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed.
Of 72 eligible articles, 51 studies involving 20 153 HIV-infected pregnant women were included. Most studies were from United States (n = 14, 27%) followed by Kenya (n = 6, 12%), South Africa (n = 5, 10%), and Zambia (n = 5, 10%). The threshold defining good adherence to ART varied across studies (>80, >90, >95, 100%). A pooled analysis of all studies indicated a pooled estimate of 73.5% [95% confidence interval (CI) 69.3-77.5%] of pregnant women who had adequate (>80%) ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum (75.7%, 95% CI 71.5-79.7%) than during postpartum (53.0%, 95% CI 32.8-72.7%; P = 0.005). Selected reported barriers for nonadherence included physical, economic and emotional stresses, depression (especially postdelivery), alcohol or drug use, and ART dosing frequency or pill burden.
Our findings indicate that only 73.5% of pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and interventions to address them is urgently needed globally.
评估高收入、中等收入和低收入国家中，孕妇和产后的抗逆转录病毒治疗（ART）依从率。
系统综述和荟萃分析。
检索 MEDLINE、EMBASE、科学引文索引 Web 版、NLM Gateway 和谷歌学术数据库。我们纳入了所有报告 HIV 感染孕妇为主要或次要结局的研究，这些研究报告了依从率。两位独立评审员提取了关于依从性和研究特征的数据。使用随机效应模型来汇总依从率；评估敏感性、异质性和发表偏倚。
在 72 篇符合条件的文章中，有 51 项研究涉及 20153 名 HIV 感染孕妇，其中大部分来自美国（n = 14，27%），其次是肯尼亚（n = 6，12%）、南非（n = 5，10%）和赞比亚（n = 5，10%）。定义 ART 良好依从性的阈值因研究而异（>80%、>90%、>95%、100%）。对所有研究的汇总分析表明，孕妇中有 73.5%（95%置信区间 69.3-77.5%）的人依从 ART 的程度足够高。在产前（75.7%，95%置信区间 71.5-79.7%），而非产后（53.0%，95%置信区间 32.8-72.7%；P = 0.005），具有足够依从水平的孕妇比例更高。报告的非依从性的主要障碍包括身体、经济和情绪压力、抑郁（尤其是产后）、饮酒或吸毒，以及 ART 给药频率或药丸负担。
我们的发现表明，只有 73.5%的孕妇达到了最佳的 ART 依从性。在怀孕期间，特别是在产后，达到足够的 ART 依从水平是一个挑战。全球迫切需要进一步研究以调查具体的障碍和干预措施。
