Kim Maria H, Zhou Amy, Mazenga Alick, Ahmed Saeed, Markham Christine, Zomba Gerald, Simon Katie, Kazembe Peter N, Abrams Elaine J
Baylor College of Medicine Department of Pediatrics, Section of Global Health and Retrovirology, Texas Children's Hospital, Houston, Texas, United States of America.
Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
PLoS One. 2016 Feb 22;11(2):e0149527. doi: 10.1371/journal.pone.0149527. eCollection 2016.
Causes for loss-to-follow-up, including early refusals of and stopping antiretroviral therapy (ART), in Malawi's Option B+ program are poorly understood. This study examines the main barriers and facilitators to uptake and adherence to ART under Option B+. In depth interviews were conducted with HIV-infected women who were pregnant or postpartum in Lilongwe, Malawi (N = 65). Study participants included women who refused ART initiation (N = 10), initiated ART and then stopped (N = 26), and those who initiated ART and remained on treatment (N = 29). The barriers to ART initiation were varied and included concerns about partner support, feeling healthy, and needing time to think. The main reasons for stopping ART included side effects and lack of partner support. A substantial number of women started ART after initially refusing or stopping ART. There were several facilitators for re-starting ART, including encouragement from community health workers, side effects subsiding, decline in health, change in partner, and fear of future sickness. Amongst those who remained on ART, desire to prevent transmission and improve health were the most influential facilitators. Reasons for refusing and stopping ART were varied. ART-related side effects and feeling healthy were common barriers to ART initiation and adherence. Providing consistent pre-ART counseling, early support for patients experiencing side effects, and targeted efforts to bring women who stop treatment back into care may improve long term health outcomes.
在马拉维的B+方案中，失访的原因，包括早期拒绝和停止抗逆转录病毒疗法（ART），目前了解甚少。本研究调查了B+方案下接受和坚持ART的主要障碍及促进因素。对马拉维利隆圭的怀孕或产后感染艾滋病毒的妇女进行了深入访谈（N = 65）。研究参与者包括拒绝开始ART的妇女（N = 10）、开始ART后又停止的妇女（N = 26）以及开始ART并继续接受治疗的妇女（N = 29）。开始ART的障碍多种多样，包括对伴侣支持的担忧、感觉健康以及需要时间思考。停止ART的主要原因包括副作用和缺乏伴侣支持。相当多的妇女在最初拒绝或停止ART后又开始了ART。重新开始ART有几个促进因素，包括社区卫生工作者的鼓励、副作用消退、健康状况下降、伴侣变化以及对未来患病的恐惧。在继续接受ART的人中，预防传播和改善健康的愿望是最有影响力的促进因素。拒绝和停止ART的原因各不相同。与ART相关的副作用和感觉健康是开始ART和坚持治疗的常见障碍。提供持续的ART前咨询、对出现副作用的患者尽早给予支持，以及有针对性地努力让停止治疗的妇女重新接受治疗，可能会改善长期健康结果。
