Stinson Kathryn, Myer Landon
a School of Public Health and Family Medicine, Centre for Infectious Disease Epidemiology and Research , University of Cape Town , Falmouth Building, Observatory , 7925 , Cape Town , South Africa.
Afr J AIDS Res. 2012 Mar;11(1):65-73. doi: 10.2989/16085906.2012.671263.
Despite the rapid expansion of antiretroviral therapy (ART) programmes, uptake of ART in pregnancy remains suboptimal. Little is known about the barriers to initiating lifelong ART in pregnancy and the challenges to postpartum retention in HIV care, particularly in sub-Saharan African contexts with a high burden of disease. In this qualitative study, 28 HIV-positive pregnant or postpartum women, who either had initiated ART or were eligible for ART, and 21 service providers were interviewed in Cape Town, South Africa, to investigate these barriers. Prevention of vertical transmission of HIV was often the primary motivation for starting treatment. Key challenges to ART initiation included late first presentation, denial of an HIV diagnosis, fear of disclosure, and treatment side-effects. The women expressed difficulties in accepting a lifelong commitment to treatment for maternal health benefit. Pregnant women who require ART face a triple burden of transitioning into pregnancy, accepting the HIV diagnosis, and recognising the urgent requirement to start lifelong ART before delivery. Focused interventions are required to address the psychosocial barriers to ART uptake and the linkages to care for pregnant HIV-positive women.
尽管抗逆转录病毒疗法（ART）项目迅速扩大，但孕期抗逆转录病毒疗法的使用率仍不理想。对于孕期启动终身抗逆转录病毒疗法的障碍以及产后留在艾滋病毒护理中的挑战，人们知之甚少，尤其是在疾病负担沉重的撒哈拉以南非洲地区。在这项定性研究中，对南非开普敦的28名已开始接受抗逆转录病毒疗法或符合治疗条件的艾滋病毒呈阳性的孕妇或产后妇女以及21名服务提供者进行了访谈，以调查这些障碍。预防艾滋病毒垂直传播通常是开始治疗的主要动机。启动抗逆转录病毒疗法的主要挑战包括首次就诊过晚、拒绝艾滋病毒诊断、害怕披露病情以及治疗副作用。这些妇女表示难以接受为了孕产妇健康利益而终身接受治疗的承诺。需要接受抗逆转录病毒疗法的孕妇面临着三重负担，即过渡到孕期、接受艾滋病毒诊断以及认识到在分娩前开始终身抗逆转录病毒疗法的迫切需要。需要有针对性的干预措施来解决接受抗逆转录病毒疗法的心理社会障碍以及与艾滋病毒呈阳性孕妇护理的联系。
