Etoori David, Renju Jenny, Reniers Georges, Ndhlovu Violet, Ndubane Sherly, Makhubela Princess, Maritze Meriam, Gomez-Olive Francesc Xavier, Wringe Alison
Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Glob Public Health. 2021 Feb;16(2):186-200. doi: 10.1080/17441692.2020.1795220. Epub 2020 Jul 16.
Few studies have explored the relationship between early infant diagnosis (EID) of HIV and mothers' engagement in care under Option B+. We conducted in-depth interviews with 20 women who initiated antiretroviral therapy (ART) under Option B+ in rural South Africa to explore the interactions between EID and maternal care engagement. Drawing on practice theory, we identified themes relating to Option B+ care engagement and EID. Women's practice of engagement with HIV care shaped their decision-making around EID. Mothers who disengaged from care during pregnancy were less inclined to utilise EID as they lacked information about its availability and benefits. For some mothers, tensions between wanting to breastfeed and perceptions that it could facilitate transmission led to repeated utilisation of EID as reassurance that the child remained negative. Some mothers used their child's negative result as a proxy for their status, subsequently disengaging from care. For some participants, an HIV diagnosis of their infant and the subsequent double burden of treatment visits for themselves and their infant, contributed to their disengagement. Women's care-seeking practices for themselves and their infants work in a symbiotic ecosystem and should be viewed interdependently to tailor interventions to improve EID uptake and Option B+ care engagement.
很少有研究探讨在“B+方案”下，婴儿早期诊断（EID）与母亲接受护理之间的关系。我们对在南非农村地区按照“B+方案”开始接受抗逆转录病毒治疗（ART）的20名女性进行了深入访谈，以探讨EID与孕产妇护理参与之间的相互作用。借鉴实践理论，我们确定了与“B+方案”护理参与和EID相关的主题。女性参与艾滋病毒护理的实践影响了她们围绕EID的决策。在怀孕期间停止接受护理的母亲不太倾向于利用EID，因为她们缺乏关于其可用性和益处的信息。对一些母亲来说，想要母乳喂养的愿望与认为母乳喂养可能促进传播的观念之间的矛盾，导致她们反复利用EID来确保孩子仍然呈阴性。一些母亲将孩子的阴性结果作为自己状况的替代指标，随后停止接受护理。对一些参与者来说，婴儿的艾滋病毒诊断以及随后她们自己和婴儿双重的治疗就诊负担，导致她们停止接受护理。女性为自己和婴儿寻求护理的行为在一个共生的生态系统中发挥作用，应该相互依存地看待，以便量身定制干预措施，以提高EID的接受率和“B+方案”护理参与度。
