*Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC; †Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC; and ‡Witkoppen Health and Welfare Centre, Johannesburg, South Africa.
J Acquir Immune Defic Syndr. 2014 Sep 1;67(1):e12-8. doi: 10.1097/QAI.0000000000000263.
Women initiating antiretroviral therapy during pregnancy have high rates of dropout, particularly after delivery. We aimed to identify challenges to postpartum retention in care under Option B+, which expands antiretroviral therapy access to all HIV-positive pregnant women regardless of CD4 count.
We performed 2 semi-structured interviews (SSI, n = 50) and 1 focus group discussion (n = 8) with HIV-positive women at Witkoppen Health and Welfare Centre, a primary care facility in Johannesburg, South Africa, that is one of the only clinics offering Option B+ in South Africa.
Fifty women completed the SSI before delivery, and 48 (96%) completed the second SSI within 3 months of delivery. Median age was 28 years (interquartile range: 26-34); most women worked (62%) or had worked in the previous year (18%). Postpartum women attending HIV care perceived that barriers to HIV care after delivery among other women included the belief that mothers care more about the baby's health than their own (29.2%, 14/48), women were "ignorant" or "irresponsible" (16.7%, 8/48), negative clinic staff treatment (12.5%, 6/48), and denial or lack of disclosure of HIV status (10.4% each, 5/48). Experienced barriers included lack of money (18.0%, 9/50), work conflict (6.0%, 3/50), and negative staff treatment (6.0%, 3/50). During the focus group discussion, 3 main themes emerged: conflict with work commitment, negative treatment from health-care workers, and lack of disclosure related to stigma.
We identified a complex set of interconnected barriers to retaining postpartum women in HIV care under Option B+, including structural, personal, and societal barriers. The importance of postpartum HIV care for the mother's own health must be embraced by health-care workers and public health programs.
在怀孕时开始接受抗逆转录病毒治疗的女性，尤其是在分娩后，退出治疗的比例很高。我们旨在确定在“B 方案+”下，产后坚持接受护理的挑战，“B 方案+”扩大了抗逆转录病毒治疗的范围，涵盖所有 HIV 阳性孕妇，无论 CD4 计数如何。
我们在南非约翰内斯堡的 Witkoppen 卫生和福利中心进行了 2 次半结构化访谈（SSI，n=50）和 1 次焦点小组讨论（n=8），该中心是南非唯一提供“B 方案+”的诊所之一。
50 名女性在分娩前完成了 SSI，其中 48 名（96%）在分娩后 3 个月内完成了第二次 SSI。中位年龄为 28 岁（四分位距：26-34）；大多数女性有工作（62%）或在过去一年中有工作（18%）。参加 HIV 护理的产后妇女认为，其他女性在产后继续接受 HIV 护理的障碍包括：母亲更关心婴儿的健康而不是自己的健康（29.2%，48/165）、女性“无知”或“不负责任”（16.7%，48/289）、诊所工作人员的负面待遇（12.5%，48/386）以及对 HIV 状况的否认或隐瞒（各 10.4%，48/462）。经历过的障碍包括缺钱（18.0%，28/155）、工作冲突（6.0%，18/300）和工作人员的负面待遇（6.0%，18/300）。在焦点小组讨论中，出现了 3 个主要主题：与工作承诺的冲突、医疗保健工作者的负面待遇以及与耻辱感相关的缺乏披露。
我们发现了一系列复杂的、相互关联的障碍，这些障碍会导致“B 方案+”下的产后女性难以坚持接受 HIV 护理，包括结构性、个人和社会障碍。医疗保健工作者和公共卫生项目必须接受产后 HIV 护理对母亲自身健康的重要性。
