Richter Linda, Rotheram-Borus Mary Jane, Van Heerden Alastair, Stein Alan, Tomlinson Mark, Harwood Jessica M, Rochat Tamsen, Van Rooyen Heidi, Comulada W Scott, Tang Zihling
Human Sciences Research Council, Durban, KwaZulu-Natal, South Africa.
AIDS Behav. 2014 Apr;18(4):706-15. doi: 10.1007/s10461-014-0694-2.
Throughout Africa, Peer Mentors who are women living with HIV (WLH) are supporting pregnant WLH at antenatal and primary healthcare clinics (McColl in BMJ 344:e1590, 2012). We evaluate a program using this intervention strategy at 1.5 months post-birth. In a cluster randomized controlled trial in KwaZulu-Natal, South Africa, eight clinics were randomized for their WLH to receive either: standard care (SC), based on national guidelines to prevent mother-to-child transmission (4 clinics; n = 656 WLH); or an enhanced intervention (EI; 4 clinics; n = 544 WLH). The EI consisted of four antenatal and four postnatal small group sessions led by Peer Mentors, in addition to SC. WLH were recruited during pregnancy and 70 % were reassessed at 1.5 months post-birth. EI's effect was ascertained on 16 measures of maternal and infant well-being using random effects regressions to control for clinic clustering. A binomial test for correlated outcomes evaluated EI's overall effectiveness. Among EI WLH reassessed, 87 % attended at least one intervention session (mean 4.1, SD 2.0). Significant overall benefits were found in EI compared to SC using the binomial test. However, it is important to note that EI WLH were significantly less likely to adhere to ARV during pregnancy compared to SC. Secondarily, compared to SC, EI WLH were more likely to ask partners to test for HIV, better protected their infants from HIV transmission, and were less likely to have depressed mood and stunted infants. Adherence to clinic intervention groups was low, yet, there were benefits for maternal and infant health at 1.5 months post-birth.
在整个非洲，感染艾滋病毒的女性同伴辅导员正在产前和初级保健诊所为感染艾滋病毒的孕妇提供支持（麦科尔，《英国医学杂志》344:e1590，2012年）。我们在产后1.5个月评估了一项采用这种干预策略的项目。在南非夸祖鲁 - 纳塔尔省进行的一项整群随机对照试验中，八家诊所被随机分配，其感染艾滋病毒的女性接受以下两种方式之一：基于国家预防母婴传播指南的标准护理（SC）（4家诊所；n = 656名感染艾滋病毒的女性）；或强化干预（EI）（4家诊所；n = 544名感染艾滋病毒的女性）。EI除了包括SC外，还包括由同伴辅导员主持的四次产前和四次产后小组会议。感染艾滋病毒的女性在孕期被招募，70%在产后1.5个月接受重新评估。使用随机效应回归来控制诊所聚类，以确定EI对16项母婴健康指标的影响。对相关结果进行二项式检验以评估EI的总体有效性。在接受重新评估的EI组感染艾滋病毒的女性中，87%至少参加了一次干预会议（平均4.1次，标准差2.0）。使用二项式检验发现，与SC相比，EI有显著的总体益处。然而，需要注意的是，与SC相比，EI组感染艾滋病毒的女性在孕期坚持服用抗逆转录病毒药物的可能性显著降低。其次，与SC相比，EI组感染艾滋病毒的女性更有可能要求伴侣进行艾滋病毒检测，能更好地保护婴儿免受艾滋病毒传播，且出现情绪低落和婴儿发育迟缓的可能性较小。对诊所干预组的依从性较低，然而，在产后1.5个月时对母婴健康仍有益处。
