Institute for Global Health, University of Southern California, Los Angeles, California, United States of America; MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; University of Nairobi Institute for Tropical and Infectious Diseases, Nairobi, Kenya.
Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS One. 2014 Mar 19;9(3):e89764. doi: 10.1371/journal.pone.0089764. eCollection 2014.
There has been insufficient attention to long-term care and treatment for pregnant women diagnosed with HIV.
This prospective cohort study of 100 HIV-positive women recruited within pregnancy-related services in a district hospital in Kenya employed quantitative methods to assess attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services. Qualitative methods were used to explore barriers and facilitators to navigating these services. Structured questionnaires were administered to cohort participants at enrolment and 90+ days later. Participants' medical records were monitored prospectively. Semi-structured qualitative interviews were carried out with a sub-set of 19 participants.
Only 53/100 (53%) women registered at an HIV clinic within 90 days of HIV diagnosis, of whom 27/53 (51%) had a CD4 count result in their file. 11/27 (41%) women were eligible for immediate antiretroviral therapy (ART); only 6/11 (55%) started ART during study follow-up. In multivariable logistic regression analysis, factors associated with registration at the HIV clinic within 90 days of HIV diagnosis were: having cared for someone with HIV (aOR:3.67(95%CI:1.22, 11.09)), not having to pay for transport to the hospital (aOR:2.73(95%CI:1.09, 6.84)), and having received enough information to decide to have an HIV test (aOR:3.61(95%CI:0.83, 15.71)). Qualitative data revealed multiple factors underlying high patient drop-out related to women's social support networks (e.g. partner's attitude to HIV status), interactions with health workers (e.g. being given unclear/incorrect HIV-related information) and health services characteristics (e.g. restricted opening hours, long waiting times).
HIV testing within pregnancy-related services is an important entry point to HIV care and treatment services, but few women successfully completed the steps needed for assessment of their treatment needs within three months of diagnosis. Programmatic recommendations include simplified pathways to care, better-tailored counselling, integration of ART into antenatal services, and facilitation of social support.
针对已确诊 HIV 的孕妇，长期护理和治疗的关注度不足。
这项前瞻性队列研究纳入了肯尼亚一家地区医院的妊娠相关服务中招募的 100 名 HIV 阳性孕妇，采用定量方法评估在妊娠相关服务中 HIV 阳性检测的女性与获得长期 HIV 护理和治疗服务之间的人员流失情况。采用定性方法探讨了这些服务的障碍和促进因素。在入组时和 90 天以上时，对队列参与者进行了结构问卷评估。前瞻性监测参与者的医疗记录。对 19 名参与者中的一部分进行了半结构化定性访谈。
仅 53/100（53%）名妇女在 HIV 诊断后 90 天内在 HIV 诊所登记，其中 27/53（51%）名妇女的档案中有 CD4 计数结果。27 名妇女中有 11 名（41%）符合立即开始抗逆转录病毒治疗（ART）的条件；只有 6/11（55%）名妇女在研究随访期间开始接受 ART。在多变量逻辑回归分析中，与 HIV 诊断后 90 天内在 HIV 诊所登记相关的因素包括：照顾过 HIV 感染者（比值比：3.67（95%置信区间：1.22，11.09））、无需支付前往医院的交通费用（比值比：2.73（95%置信区间：1.09，6.84））和获得足够的信息来决定进行 HIV 检测（比值比：3.61（95%置信区间：0.83，15.71））。定性数据揭示了与妇女社会支持网络（例如伴侣对 HIV 状况的态度）、与卫生工作者的互动（例如提供不明确/不正确的 HIV 相关信息）和卫生服务特征（例如开放时间有限，等待时间长）相关的高患者流失率的多个因素。
妊娠相关服务中的 HIV 检测是 HIV 护理和治疗服务的重要切入点，但很少有妇女在诊断后三个月内成功完成评估其治疗需求所需的步骤。项目建议包括简化护理途径、更好地量身定制咨询、将抗逆转录病毒治疗纳入产前服务以及促进社会支持。
