Department of Family Medicine & Rural Health, Faculty of Health Science, Walter Sisulu University, Mthatha/East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa.
Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50, Church Street, East London, South Africa.
BMC Infect Dis. 2018 Apr 13;18(1):175. doi: 10.1186/s12879-018-3087-8.
Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa.
This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence.
A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART.
Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit.
特定情境下的因素会影响感染艾滋病毒的孕妇对艾滋病抗病毒治疗（ART）的依从性。南非卫生机构层面预防母婴传播（PMTCT）项目的结果存在差异，人们对其原因的理解尚存在空白。本研究调查了在南非东开普省参加 PMTCT 项目的产妇队列在怀孕期间的依从水平和不依从的原因。
这是一项混合方法研究，涉及南非东开普省的 1709 名产妇。我们于 2016 年对 PMTCT 电子数据库中的母婴对进行了多中心回顾性分析。对自我报告依从性差的 177 名产妇进行了有针对性的半结构式访谈，以了解依从性的主要障碍。采用二元逻辑回归分析确定 ART 不依从的独立预测因素。
很大比例（69.0%）的女性报告完全依从。在逻辑回归分析中，调整混杂因素后，婚姻状况、吸烟、饮酒和未向家庭成员透露是不依从的独立预测因素。对定性数据的分析表明，药物相关副作用、离家、健忘、未透露、耻辱感和工作相关需求是不依从 ART 的主要原因。
在这种情况下，孕妇不依从抗逆转录病毒治疗与生活方式行为、艾滋病毒相关耻辱感和 ART 副作用有关。为了消除艾滋病毒母婴传播，临床医生需要在每次产前检查时筛查这些因素。
