Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
Africa Health Research Institute, Kwazulu-Natal, South Africa.
AIDS Behav. 2019 Jul;23(7):1689-1697. doi: 10.1007/s10461-018-2324-x.
HIV-positive pregnant women who are initiated on lifelong antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) have lower adherence rates after delivery. We quantified maternal motivation to take preventive therapy before and after delivery among pregnant women newly diagnosed with HIV. We enrolled pregnant women (≥ 18 years) with a recent HIV diagnosis (< 6 months) at 14 public primary health clinics in Matlosana, South Africa and followed them in the postpartum period. Participants received eight choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapy identified through literature reviews and key informant interviews. Data was analyzed using conditional logit regression in the antepartum versus postpartum periods. Coefficients are reported with 95% confidence intervals (CI). Sixty-five women completed surveys both at enrollment and in the postpartum period. All women were already on ART, while 21 (32%) were receiving IPT at enrollment. The mean CD4 count was 436 (± 246) cells/mm. In the antepartum period, preventing HIV transmission to partners was the most important benefit (coefficients (ß) = 0.87, 95% CI 0.64, 1.11), followed by keeping healthy for family (ß = 0.75, 95% CI 0.52, 0.97). Such prioritization significantly decreased in the postpartum period (p < 0.001). Compared to other motivators, keeping a high CD4 count was least prioritized in the antepartum period (ß = 0.19, 95% CI - 0.04, 0.43) but was most prioritized in the postpartum period (ß = 0.39, 95% CI 0.21, 0.57). These results highlight that messages on family might be particularly salient in the antepartum period, and keeping CD4 count high in the postpartum period. Understanding maternal motivation may help to design targeted health promotion messages to HIV-positive women around the time of delivery.
HIV 阳性的孕妇如果开始接受终身抗逆转录病毒治疗（ART）和异烟肼预防治疗（IPT），那么在分娩后其服药依从性会更低。我们定量评估了新诊断为 HIV 阳性的孕妇在分娩前后接受预防治疗的动机。我们在南非马特洛萨纳的 14 家公立初级保健诊所招募了最近被诊断出 HIV 感染（<6 个月）的孕妇（≥18 岁），并在产后对她们进行了随访。参与者接受了八项选择任务，这些任务比较了通过文献回顾和关键知情者访谈确定的与预防治疗相关的七个可能的益处中的两个互斥子集。使用产前和产后时期的条件逻辑回归分析数据。报告系数及其 95%置信区间（CI）。65 名妇女在入组时和产后都完成了调查。所有妇女都已经开始接受 ART，而 21 名妇女（32%）在入组时正在接受 IPT。平均 CD4 计数为 436（±246）个细胞/mm。在产前阶段，预防艾滋病毒传播给伴侣是最重要的益处（系数（ß）=0.87，95%CI 0.64，1.11），其次是为了家人保持健康（ß=0.75，95%CI 0.52，0.97）。这种优先级在产后阶段显著降低（p<0.001）。与其他动机相比，保持较高的 CD4 计数在产前阶段的优先级最低（ß=0.19，95%CI -0.04，0.43），但在产后阶段的优先级最高（ß=0.39，95%CI 0.21，0.57）。这些结果表明，家庭相关的信息在产前阶段可能特别重要，而保持 CD4 计数高在产后阶段则更为重要。了解产妇的动机可能有助于围绕分娩时间为 HIV 阳性妇女设计有针对性的健康促进信息。
