Lytvyn Lyubov, Siemieniuk Reed A, Dilmitis Sophie, Ion Allyson, Chang Yaping, Bala Malgorzata M, Manja Veena, Mirza Reza, Rodriguez-Gutierrez Rene, Mir Hassan, El Dib Regina, Banfield Laura, Vandvik Per Olav, Bewley Susan
Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
BMJ Open. 2017 Sep 11;7(9):e019023. doi: 10.1136/bmjopen-2017-019023.
To investigate women's values and preferences regarding antiretroviral therapy (ART) during pregnancy to inform a Rapid Recommendation.
Primary studies reporting patient-reported outcomes relevant to decision-making regarding ART in any clinical and geographical setting.
Women living with HIV who are pregnant, postpartum or considering pregnancy.
Quantitative measurements and qualitative descriptions of values and preferences in relation to ART during pregnancy. We also included studies on women's reported barriers and facilitators to adherence. We excluded studies correlating objective measures (eg, CD4 count) with adherence, or reporting only outcomes which are not expected to differ between ART alternatives (eg, access to services, knowledge about ART).
We included 15 qualitative studies reporting values and preferences about ART in the peripartum period; no study directly studied choice of ART therapy during pregnancy. Six themes emerged: a desire to reduce vertical transmission (nine studies), desire for child to be healthy (five studies), concern about side effects to the child (eight studies), desire for oneself to be healthy (five studies), distress about side effect to oneself (10 studies) and pill burden (two studies). None of the studies weighed the relative importance of these outcomes directly, but pill burden/medication complexity appears to be a lower priority for most women compared with other factors. Overall, the body of evidence was at low risk of bias, with minor limitations.
Women who are or may become pregnant and who are considering ART appear to place a high value on both their own and their children's health. Evidence on the relative importance between these values when choosing between ART regimens is uncertain. There is variability in individual values and preferences among women. This highlights the importance of an individualised women-centred approach, such as shared decision-making when choosing between ART alternatives.
International Prospective Register of Systematic Reviews:CRD42017057157.
调查女性在孕期对抗逆转录病毒疗法（ART）的价值观和偏好，以形成快速推荐意见。
在任何临床和地理环境中，报告与ART决策相关的患者报告结局的原始研究。
怀孕、产后或考虑怀孕的感染HIV的女性。
孕期与ART相关的价值观和偏好的定量测量和定性描述。我们还纳入了关于女性报告的坚持治疗的障碍和促进因素的研究。我们排除了将客观指标（如CD4细胞计数）与坚持治疗相关联的研究，或仅报告ART替代方案之间预期无差异的结局（如获得服务、关于ART的知识）的研究。
我们纳入了15项定性研究，报告了围产期对ART的价值观和偏好；没有研究直接研究孕期ART疗法的选择。出现了六个主题：降低垂直传播的愿望（9项研究）、希望孩子健康（5项研究）、对孩子副作用的担忧（8项研究）、希望自己健康（5项研究）、对自身副作用的困扰（10项研究）和药片负担（2项研究）。没有研究直接权衡这些结局的相对重要性，但与其他因素相比，药片负担/药物复杂性对大多数女性来说似乎是较低的优先事项。总体而言，证据体的偏倚风险较低，有一些小的局限性。
正在或可能怀孕且正在考虑ART的女性似乎非常重视自身和孩子的健康。在选择ART方案时，这些价值观之间相对重要性的证据尚不确定。女性个体的价值观和偏好存在差异。这凸显了以女性为中心的个体化方法的重要性，例如在选择ART替代方案时进行共同决策。
国际系统评价前瞻性注册库：CRD42017057157
