为自身健康接受治疗的HIV-1感染女性产后抗逆转录病毒治疗依从性差的原因：坦桑尼亚Mitra Plus研究的经验
Reasons for poor adherence to antiretroviral therapy postnatally in HIV-1 infected women treated for their own health: experiences from the Mitra Plus study in Tanzania.
作者信息
Ngarina Matilda, Popenoe Rebecca, Kilewo Charles, Biberfeld Gunnel, Ekstrom Anna Mia
机构信息
Department of Obstetrics and Gynaecology, Muhimbili National Hospital, P,O, Box 65561, Dar es Salaam, Tanzania.
出版信息
BMC Public Health. 2013 May 7;13:450. doi: 10.1186/1471-2458-13-450.
BACKGROUND
In a study of prevention of mother-to-child transmission of HIV (PMTCT) by triple antiretroviral therapy (ART) in Dar es Salaam, Tanzania (the Mitra Plus study), retrospective viral load testing revealed a high and increasing frequency of detectable viral load during follow-up for two years postnatally in women given continuous ART for their own health suggesting poor adherence. This study explored women's own perceived barriers to adherence to ART post-delivery so as to identify ways to facilitate better drug adherence among women in need of ART for their own health.
METHODS
Semi-structured interviews were conducted with 23 of the 48 women who had detectable viral load at 24 months postnatally. Content analysis was used to analyze the data.
RESULTS
Most women in the study did not acknowledge poor adherence until confronted with the viral load figures. Then, however, they revealed multiple reasons for failing to adhere. They said that their motivation to take ART decreased once they had protected their children from becoming infected and successfully weaned them. Feeling well for some, and a feeling of hopelessness for others, also decreased motivation to continue ART. The overwhelming demands of everyday life, poverty and lack of empowerment also posed significant barriers to long-term adherence. The need to keep their HIV status a secret and not let anyone see them taking the drugs was another steep barrier.
CONCLUSION
Reasons for postnatal failure to adhere by mothers put on ART for life during pregnancy included lack of motivation to continue ART after weaning the child, poverty and stigma. Projects that simultaneously address stigma, poverty and women's lack of empowerment may be necessary for PMTCT and ART to reach their full potential. Our results indicate that the new WHO proposal to start all HIV-infected pregnant women on lifelong ART regardless of CD4 cell count needs to address the challenging realities of women in resource-poor contexts if it is to be successful.
背景
在坦桑尼亚达累斯萨拉姆开展的一项关于通过三联抗逆转录病毒疗法（ART）预防母婴传播艾滋病毒（PMTCT）的研究（米特拉加研究）中，回顾性病毒载量检测显示，在产后两年的随访期间，为自身健康接受持续ART治疗的女性中，可检测到病毒载量的频率很高且不断增加，这表明依从性较差。本研究探讨了产后女性在坚持ART治疗方面自身感知到的障碍，以便找出促进有自身健康需求的女性更好地坚持服药的方法。
方法
对产后24个月病毒载量可检测到的48名女性中的23名进行了半结构式访谈。采用内容分析法对数据进行分析。
结果
研究中的大多数女性在面对病毒载量数据之前并未意识到依从性差。然而，之后她们揭示了不坚持治疗的多种原因。她们表示，一旦保护孩子免受感染并成功断奶，她们服用ART的动力就会下降。对一些人来说感觉良好，而对另一些人来说感到绝望，这也降低了继续接受ART治疗的动力。日常生活的巨大压力、贫困和缺乏自主权也对长期依从性构成了重大障碍。需要对自己的艾滋病毒感染状况保密，不让任何人看到她们服药，这也是一个巨大的障碍。
结论
孕期接受ART治疗的母亲产后不坚持治疗的原因包括断奶后缺乏继续接受ART治疗的动力、贫困和耻辱感。对于PMTCT和ART充分发挥其潜力而言，可能需要开展同时解决耻辱感、贫困和女性缺乏自主权问题的项目。我们的结果表明，世界卫生组织关于让所有感染艾滋病毒的孕妇无论CD4细胞计数如何都开始终身接受ART治疗的新提议，若要取得成功，就需要应对资源匮乏环境中女性面临的严峻现实。
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