Maman Suzanne, Moodley Dhayendre, McNaughton-Reyes Heathe Luz, Groves Allison K, Kagee Ashraf, Moodley Prashini
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
University of KwaZulu-Natal, Durban, South Africa.
PLoS One. 2014 May 13;9(5):e97092. doi: 10.1371/journal.pone.0097092. eCollection 2014.
Pregnancy and the postpartum period present important intervention opportunities. Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants.
Pregnant women attending an antenatal clinic in South Africa were randomly allocated to treatment (n=733) and control arms (n=747). Treatment arm participants received enhanced HIV pre- and post-test counseling, legal support and access to support groups at baseline, which occurred at the first antenatal visit, and then six and ten weeks postpartum. Control arm participants received standard HIV testing and counseling (HTC) and two postpartum attention control sessions. Outcomes were incidence of sexually transmitted infection (STI) by 14 weeks postpartum and past 30-day inconsistent condom use at 14 weeks and 9 months postpartum.
There were no intervention effects on incident STIs for either HIV-negative (adjusted risk ratio (aRR) 1.01, 95% CI 0.71-1.44) or HIV-positive participants (aRR 0.86, 95% CI 0.61-1.23). The intervention was associated with a 28% decrease in risk of past 30-day inconsistent condom use at nine-months among HIV-negative women (aRR 0.72,95% CI 0.59-0.88), but did not affect inconsistent condom use among HIV-positive women (aRR1.08; 95% CI 0.67-1.75).
An enhanced counseling intervention during pregnancy and the postpartum period can lead to reductions in inconsistent condom use among HIV-negative women. Results underscore the importance of the counseling that accompanies HIV HTC. More work is needed to understand how to promote and sustain risk reduction among HIV-positive women.
ClinicalTrials.gov NCT01683461.
孕期及产后阶段存在重要的干预机会。咨询可利用女性在此期间改变可能对自身健康及婴儿健康产生负面影响的行为的动机。
在南非一家产前诊所就诊的孕妇被随机分为治疗组（n = 733）和对照组（n = 747）。治疗组参与者在基线时（首次产前检查时）、产后六周和产后十周接受强化的HIV检测前后咨询、法律支持并可参加支持小组。对照组参与者接受标准的HIV检测与咨询（HTC）以及两次产后关注控制环节。观察指标为产后14周时性传播感染（STI）的发生率，以及产后14周和9个月时过去30天内避孕套使用不一致的情况。
对于HIV阴性参与者（调整风险比（aRR）1.01，95%置信区间0.71 - 1.44）或HIV阳性参与者（aRR 0.86，95%置信区间0.61 - 1.23），干预措施对STI的发病情况均无影响。该干预措施使HIV阴性女性在九个月时过去30天内避孕套使用不一致的风险降低了28%（aRR 0.72，95%置信区间0.59 - 0.88），但对HIV阳性女性避孕套使用不一致的情况没有影响（aRR 1.08；95%置信区间0.67 - 1.75）。
孕期及产后阶段强化咨询干预可降低HIV阴性女性避孕套使用不一致的情况。结果强调了HIV检测与咨询（HTC）过程中咨询的重要性。需要开展更多工作以了解如何促进并维持HIV阳性女性的风险降低。
ClinicalTrials.gov NCT01683461
