Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
PLoS One. 2020 Aug 27;15(8):e0238232. doi: 10.1371/journal.pone.0238232. eCollection 2020.
Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services.
We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis.
We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement.
In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.
尽管预防母婴传播艾滋病毒（PMTCT）项目取得了广泛成功，但在怀孕和产后期间，艾滋病毒护理的参与度仍不理想。本研究探讨了那些在参与 PMTCT 护理方面遇到挑战的女性的观点，以便更好地了解导致保留率低的因素，并确定改善 PMTCT 服务的机会。
我们对 12 名产后妇女进行了深入访谈，讨论她们在 PMTCT 护理方面的经验。我们利用在坦桑尼亚莫希的五家 PMTCT 诊所进行的一项更大的纵向队列研究的数据，确定了具有不良护理参与指标的妇女（即药物不依从、诊所就诊不规律或病毒载量高）。符合这些标准之一的妇女通过电话联系并邀请她们完成访谈。使用应用主题分析方法对数据进行分析。
我们观察到一条共同途径，即对污名的恐惧导致缺乏艾滋病毒披露，并减少了寻求艾滋病毒护理的社会支持。妇女通常不信任最初艾滋病毒检测的结果，并在开始护理后报告药物副作用。妇女还报告了卫生系统中的障碍，包括难以导航的诊所转移政策以及服务提供中缺乏隐私和保密性。当被问及如何改善护理时，妇女们认为改善咨询和随访、肯定医患互动以及同伴治疗支持者将对护理参与产生积极影响。
为了提高 PMTCT 项目的效果，需要对护理参与度差的患者进行积极的跟踪和随访。有针对性的支持性干预措施可能有助于患者应对艾滋病毒污名的感知和实际影响，包括向亲人披露和获得社会支持。促进艾滋病毒的接受度可能有助于患者承诺长期治疗。
