在产前保健环境中实施夫妻艾滋病毒检测和咨询。

Implementing Couple's Human Immunodeficiency Virus Testing and Counseling in the Antenatal Care Setting.

机构信息

Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, the Departments of Obstetrics & Gynecology and Psychiatry, Drexel University College of Medicine, the AIDS Activities Coordinating Office, Philadelphia Department of Public Health, the Undergraduate Program in Neurosciences, University of Pennsylvania, and the Department of Community and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania; and Massachusetts General Hospital, School of Public Health, Boston, Massachusetts.

出版信息

Obstet Gynecol. 2020 Sep;136(3):582-590. doi: 10.1097/AOG.0000000000003932.

DOI:10.1097/AOG.0000000000003932

PMID:32769640

Abstract

OBJECTIVE

To describe a pilot implementation of couple's human immunodeficiency virus (HIV) testing and counseling in an antenatal care clinic in the United States.

METHODS

We used a cross-sectional study design. Couples were recruited from an antenatal care clinic of a large, urban, tertiary medical center, and were eligible if both partners agreed to receive HIV test results together and reported no coercion to participate in testing and counseling and no intimate partner violence. We assessed relationship characteristics, HIV risk-related behaviors and concordance of couples' sexual agreement (ie, mutual agreement about sexual risk behaviors that are permissible within or outside of their relationship). Acceptability of couple's HIV testing and counseling (ie, format, quality of the sessions, ability to meet their needs) was assessed after completing the session. Barriers and facilitators to couple's HIV testing and counseling were assessed at the individual-level among decliners and participants and at the clinic-level among members of the care team.

RESULTS

Dyadic data were collected from 82 individuals (41 couples). Most partners (n=56, 68%) did not have a sexual agreement or had differing expectations about their sexual agreement. Partners with a concordant sexual agreement (n=26) felt more confident working with their partners on condom use when having sex outside of their relationship (P=.008) and were more likely to agree with their partner to get tested regularly for HIV or sexually transmitted infections (P=.015). Acceptability was high, with a rating of 93 or more (out of 100) among all items. Individual-level barriers to couple's HIV testing and counseling included difficulty bringing the male partner for counseling and a perception by either member of the couple that they were at low-risk for HIV. At the clinic level, need for training, staff turnover, and integration of couple's HIV testing and counseling in the clinic flow presented as barriers, whereas commitment by the clinic leadership facilitated the couple's HIV testing and counseling program.

CONCLUSION

Despite barriers, couple's HIV testing and counseling can be implemented in antenatal clinics and is a highly acceptable method of HIV testing.

摘要

目的

描述在美国一家产前护理诊所中实施夫妻艾滋病毒（HIV）检测和咨询的试点情况。

方法

我们采用了横断面研究设计。在一家大型城市三级医疗中心的产前护理诊所招募了夫妇，只要双方都同意一起接受 HIV 检测结果，并报告没有被迫参与检测和咨询，也没有亲密伴侣暴力，就符合条件。我们评估了伴侣关系特征、与 HIV 风险相关的行为以及夫妻间性协议的一致性（即，对关系内外允许的性行为风险的共同认同）。在完成咨询后，评估了夫妻 HIV 检测和咨询的可接受性（即，形式、咨询质量、满足需求的能力）。在个人层面，我们评估了拒绝者和参与者的夫妻 HIV 检测和咨询的障碍和促进因素，以及在诊所层面，评估了护理团队成员的夫妻 HIV 检测和咨询的障碍和促进因素。

结果

从 82 个人（41 对夫妻）中收集了二元数据。大多数伴侣（n=56，68%）没有性协议，或者对他们的性协议有不同的期望。有一致性协议的伴侣（n=26）在与伴侣发生性关系时更有信心使用避孕套（P=.008），并且更有可能同意与伴侣定期接受 HIV 或性传播感染的检测（P=.015）。可接受性很高，所有项目的评分都在 93 或以上（满分 100）。夫妻 HIV 检测和咨询的个人层面障碍包括难以让男性伴侣接受咨询，以及夫妻双方中的一方认为自己感染 HIV 的风险较低。在诊所层面，需要培训、人员流动以及将夫妻 HIV 检测和咨询纳入诊所流程是障碍，而诊所领导层的承诺则促进了夫妻 HIV 检测和咨询计划。