乌克兰HIV阳性女性在孕期及产后第一年对抗逆转录病毒疗法的依从性。
Adherence to antiretroviral therapy during pregnancy and the first year postpartum among HIV-positive women in Ukraine.
作者信息
Bailey Heather, Thorne Claire, Malyuta Ruslan, Townsend Claire L, Semenenko Igor, Cortina-Borja Mario
机构信息
Population Policy and Practice Programme, UCL Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
出版信息
BMC Public Health. 2014 Sep 24;14:993. doi: 10.1186/1471-2458-14-993.
BACKGROUND
Poor adherence to antiretroviral therapy (ART) is associated with HIV disease progression and, during pregnancy, increased mother-to-child transmission risk. In Ukraine, access to combination ART is expanding but data on adherence are scarce.
METHODS
Cross-sectional surveys of HIV-positive women were conducted i) at delivery (on antenatal ART adherence) and ii) during the first year postpartum (on ART adherence in the preceding four weeks). Factors associated with a score ≤ 11 on the self-report Case Adherence Support Evaluation (CASE) index or ≥ 1 self-reported missed dose were assessed using Fisher's exact test.
RESULTS
Of 185 antenatal participants and 102 postnatal participants, median ages were 27.5 and 29.5 years respectively: 28% (50/180) and 27% (26/98) reported an unplanned pregnancy, and 13% (24/179) and 17% (17/98) an illicit drug-use history (excluding marijuana). One quarter (49/180 antenatally, 27/101 postnatally) screened positive for depression. The proportion reporting 'low' ART-related self-efficacy (i.e. unable to do ≥ 1/5 ART-taking activities) was 20% (28/141) antenatally and 17% (11/66) postnatally. Antenatally, 14% (95% CI 10-21%) had a CASE score ≤ 11 and 35% (95% CI 28-42%) reported missing ≥ 1 dose. Factors associated with a CASE score ≤ 11 were unplanned pregnancy (25% (12/48) vs. 11% (13/120) where planned, p = 0.03) and living with extended family (23% (13/57) vs. 10% (12/125) living with partner/alone, p = 0.04). Self-report of ≥ 1 missed dose antenatally was additionally associated with younger age (p = 0.03) and lower self-efficacy (50% (14/28) reported ≥ 1 missed dose vs. 28% (30/108) of those with high self-efficacy, p = 0.04). Of 102 postnatal participants, 8% (95% CI 4-15%) had a CASE score ≤ 11 and 31% (95% CI 22-41%) reported ≥ 1 missed dose. Of 11 women with low self-efficacy, 3 (27%) had a CASE score ≤ 11 compared with 3/55 (5%) of those with high self-efficacy (p = 0.05). Current smokers more commonly reported ≥ 1 missed dose postnatally (50% (13/26) vs. 25% (18/72) of non-smokers, p = 0.03).
CONCLUSIONS
Our results highlight unmet needs for counselling and support. We identify some groups at risk of poor ART adherence, including women with markers of social vulnerability and those with low ART-related self-efficacy, who may benefit from targeted interventions.
背景
抗逆转录病毒疗法（ART）依从性差与HIV疾病进展相关，且在孕期会增加母婴传播风险。在乌克兰，联合抗逆转录病毒疗法的可及性正在扩大，但关于依从性的数据却很匮乏。
方法
对HIV阳性女性进行横断面调查，一是在分娩时（关于产前抗逆转录病毒疗法依从性），二是在产后第一年（关于前四周的抗逆转录病毒疗法依从性）。使用Fisher精确检验评估与自我报告的病例依从性支持评估（CASE）指数得分≤11或自我报告漏服≥1剂相关的因素。
结果
在185名产前参与者和102名产后参与者中，中位年龄分别为27.5岁和29.5岁；28%（50/180）和27%（26/98）报告意外怀孕，13%（24/179）和17%（17/98）有非法药物使用史（不包括大麻）。四分之一（产前49/180，产后27/101）筛查出抑郁呈阳性。报告“低”抗逆转录病毒疗法相关自我效能感（即无法完成≥1/5的抗逆转录病毒疗法服药活动）的比例在产前为20%（28/141），产后为17%（11/66）。产前，14%（95%置信区间10 - 21%）的CASE得分≤11，35%（95%置信区间28 - 42%）报告漏服≥1剂。与CASE得分≤11相关的因素有意外怀孕（25%（12/48），计划内怀孕为11%（13/120），p = 0.03）以及与大家庭同住（23%（(13/57），与伴侣同住/独居为10%（12/125），p = 0.04）。产前自我报告漏服≥1剂还与年龄较小（p = 0.03）和自我效能感较低有关（自我效能感低的人群中50%（14/28）报告漏服≥1剂，自我效能感高的人群中为28%（30/108），p = 0.04）。在102名产后参与者中，8%（95%置信区间4 - 15%）的CASE得分≤11，31%（95%置信区间22 - 41%）报告漏服≥1剂。在自我效能感低的11名女性中，3名（27%）的CASE得分≤11，而自我效能感高的女性中这一比例为3/55（5%）（p = 0.05）。当前吸烟者产后更常报告漏服≥1剂（50%（13/26），非吸烟者为25%（18/72），p = 0.03）。
结论
我们的结果凸显了咨询和支持方面未满足的需求。我们确定了一些抗逆转录病毒疗法依从性差的风险人群，包括具有社会脆弱性特征的女性以及抗逆转录病毒疗法相关自我效能感低的女性，她们可能会从有针对性的干预措施中获益。
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