University of Zimbabwe College of Health Sciences, Paediatrics and Child Health, Harare, Zimbabwe.
University of Zimbabwe College of Health Sciences - Clinical Trials Research Centre, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe.
AIDS Behav. 2019 Sep;23(9):2522-2531. doi: 10.1007/s10461-019-02624-3.
The PROMISE trial enrolled asymptomatic HIV-infected pregnant and postpartum women not eligible for antiretroviral treatment (ART) per local guidelines and randomly assigned proven antiretroviral strategies to assess relative efficacy for perinatal prevention plus maternal/infant safety and maternal health. The START study subsequently demonstrated clear benefit in initiating ART regardless of CD4 count. Active PROMISE participants were informed of results and women not receiving ART were strongly recommended to immediately initiate treatment to optimize their own health. We recorded their decision and the primary reason given for accepting or rejecting the universal ART offer after receiving the START information. One-third of participants did not initiate ART after the initial session, wanting more time to consider. Six sessions were required to attain 95% uptake. The slow uptake of universal ART highlights the need to prepare individuals and sensitize communities regarding the personal and population benefits of the "Treat All" strategy.
PROMISE 试验招募了不符合当地指南规定的抗逆转录病毒治疗（ART）条件的无症状 HIV 感染孕妇和产后妇女，并随机分配已证实的抗逆转录病毒策略，以评估围产期预防以及母婴安全性和产妇健康的相对疗效。随后的 START 研究表明，无论 CD4 计数如何，开始 ART 都有明显益处。积极参与 PROMISE 的参与者被告知了研究结果，未接受 ART 的妇女被强烈建议立即开始治疗，以优化自身健康。我们记录了他们的决定，并记录了在收到 START 信息后，他们接受或拒绝普遍 ART 治疗的主要原因。三分之一的参与者在第一次就诊后没有开始接受 ART，他们希望有更多的时间考虑。需要进行六次就诊才能达到 95%的接受率。普遍接受 ART 的速度较慢，这突出表明需要让个人做好准备，并使社区认识到“治疗所有”策略对个人和人群的益处。
