Akinde Yetunde, Groves Allison K, Nkwihoreze Hervette, Aaron Erika, Alleyne Gregg, Wright Charmaine, Jemmott John, Momplaisir Florence M
Department of Community and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
Division of Infectious Diseases and HIV Medicine, School of Medicine, Drexel University, Philadelphia, Pennsylvania.
Health Equity. 2019 Jul 1;3(1):336-342. doi: 10.1089/heq.2019.0027. eCollection 2019.
Many women living with HIV (WLWH) experience poor postpartum retention in HIV care. There are limited evidence-based interventions in the United States aimed at increasing retention of WLWH postpartum; however, evidence from low-resource settings suggest that women who receive peer mentoring experience higher retention and viral suppression postpartum. We conducted 15 semistructured interviews with pregnant or postpartum women from an urban U.S. clinic to assess factors influencing maternal adherence to antiretroviral therapy (ART) and retention in HIV care. We then assessed the acceptability of a peer intervention in mitigating barriers to sustain adherence and retention in care postpartum. Interviews were audio taped, transcribed, and analyzed. Codes were developed and applied to all transcripts, and matrices were used to facilitate comparisons across different types of participants. Participants included low-income black and Hispanic women with a mean age of 31 years (range 22-42). Social support and concern for infants' well-being were strong facilitators for engaging in care. Psychosocial challenges, such as stigma and isolation, fear of disclosure, and depression, negatively influenced adherence to ART and engagement in care. Regardless of their level of adherence to ART, women felt that peer mentoring would be an acceptable intervention to reinforce skill-related ART adherence and sustain engagement in care after delivery. A peer mentor mother program is a promising intervention that can improve the care continuum of pregnant and postpartum women in the United States. Messaging that maximizes maternal support and women's motivation to keep their infant healthy may leverage retention in care postpartum.
许多感染艾滋病毒的女性（WLWH）产后在接受艾滋病毒护理方面表现不佳。在美国，旨在提高WLWH产后护理留存率的循证干预措施有限；然而，来自资源匮乏地区的证据表明，接受同伴指导的女性产后护理留存率更高，病毒抑制效果更好。我们对美国一家城市诊所的孕妇或产后女性进行了15次半结构化访谈，以评估影响母亲坚持抗逆转录病毒疗法（ART）及留存于艾滋病毒护理的因素。然后，我们评估了同伴干预在减轻产后维持坚持治疗及护理留存障碍方面的可接受性。访谈进行了录音、转录和分析。制定了编码并应用于所有转录本，并使用矩阵来促进不同类型参与者之间的比较。参与者包括低收入黑人和西班牙裔女性，平均年龄为31岁（范围22 - 42岁）。社会支持和对婴儿健康的关注是参与护理的有力促进因素。心理社会挑战，如耻辱感和孤立感、对披露的恐惧以及抑郁，对坚持ART治疗和参与护理产生了负面影响。无论她们对ART的坚持程度如何，女性都认为同伴指导是一种可接受的干预措施，有助于加强与技能相关的ART坚持，并在分娩后维持对护理的参与。同伴指导母亲计划是一种有前景的干预措施，可以改善美国孕妇和产后女性的护理连续性。最大化母亲支持和女性保持婴儿健康的动机的信息传递可能有助于提高产后护理留存率。
