Kuete Martin, Yuan HongFang, Tchoua Kemayou Aude Laure, Songo Emmanuel Ancel, Yang Fan, Ma XiuLan, Xiong ChengLiang, Zhang HuiPing
Obstetrics and Gynecology, Reproductive Center, Family Planning and Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China; Main Maternity of Obstetrics and Gynecology, Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon.
Obstetrics and Gynecology, Reproductive Center, Family Planning and Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
Patient Prefer Adherence. 2016 Oct 3;10:1967-1977. doi: 10.2147/PPA.S105624. eCollection 2016.
Integration of family planning services (FPS) into human immunodeficiency virus (HIV) care for HIV-infected women is an important aspect of the global prevention of mother-to-child transmission (PMTCT) strategy. We assessed the integration of FPS into routine care of HIV-infected mothers by evaluating the uptake and barriers of contraception and PMTCT services.
We conducted an interventional study using the interrupted time series approach in the health care facilities located in Yaounde, Cameroon. First, structured questionnaires related to family planning use, PMTCT services use, and infection risk of the sexual partner were administered to the first trimester pregnant women who were HIV infected and living with uninfected partners. Second, 2 weeks before the delivery date, the women were interviewed according to the prior counseling interventions received, in order to assess their behavior on FPS, antiretroviral therapy (ART) use, delivery option, and infant nourishment to be adopted. -values below 0.05 were considered statistically significant in the statistical analyses.
Of 94 HIV-infected women, 69% were stable couples. Only 13% of women had attended FPS before conception. Although the vast majority were knowledgeable about modern and traditional contraception methods, only 19% had experienced effective contraceptive methods. However, 66% preferred condom use, 45% having three children still expressed a desire to conceive, while 44% reported abortions, 65% had tried to avoid the current pregnancy, and 12% of women were ART naïve. Several predictors such as education, abortion rate, unplanned pregnancies, and partners' decision were associated with the nonuse of effective contraceptive methods. Moreover, barriers including sex inequity, lack of partner support, ART shortages, and lack of HIV viral load monitoring were prevalent among the participants (=0.001). However FPS use, ART compliance, and safe options to PMTCT significantly increased after the educational counseling interventions (=0.001).
Scaling up the FPS by incorporating routine PMTCT services into reproductive health care should contribute to preventing both horizontal and vertical transmission of HIV.
将计划生育服务（FPS）纳入感染人类免疫缺陷病毒（HIV）妇女的HIV护理是全球预防母婴传播（PMTCT）战略的一个重要方面。我们通过评估避孕和PMTCT服务的接受情况及障碍，来评估FPS纳入HIV感染母亲常规护理的情况。
我们在喀麦隆雅温得的医疗机构中采用中断时间序列方法进行了一项干预性研究。首先，向感染HIV且伴侣未感染的孕早期孕妇发放与计划生育使用、PMTCT服务使用以及性伴侣感染风险相关的结构化问卷。其次，在分娩日期前2周，根据接受的先前咨询干预对这些妇女进行访谈，以评估她们在FPS、抗逆转录病毒疗法（ART）使用、分娩方式选择以及婴儿喂养方面的行为。在统计分析中，P值低于0.05被认为具有统计学意义。
在94名感染HIV的妇女中，69%为稳定伴侣关系。只有13%的妇女在怀孕前接受过FPS服务。尽管绝大多数妇女了解现代和传统避孕方法，但只有19%的妇女使用过有效的避孕方法。然而66%的妇女更喜欢使用避孕套，45%育有三个孩子的妇女仍表示有生育意愿，44%的妇女报告有过堕胎经历，65%的妇女曾试图避免此次怀孕，12%的妇女未接受过ART治疗。教育程度、堕胎率、意外怀孕以及伴侣的决定等几个预测因素与未使用有效避孕方法有关。此外，参与者中普遍存在性别不平等、缺乏伴侣支持、ART短缺以及缺乏HIV病毒载量监测等障碍（P = 0.001）。然而，在接受教育咨询干预后，FPS的使用、ART依从性以及PMTCT的安全选择显著增加（P = 0.001）。
通过将常规PMTCT服务纳入生殖保健来扩大FPS服务，应有助于预防HIV的水平传播和垂直传播。
