Tsegaye Reta, Etafa Werku, Wakuma Bizuneh, Mosisa Getu, Mulisa Diriba, Tolossa Tadesse
School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
BMC Public Health. 2020 Nov 27;20(1):1812. doi: 10.1186/s12889-020-09903-y.
Despite coverage and benefits associated with the prevention of mothers to child transmission (PMTCT) services, mothers' adherence to option B plus is still a challenge. Though few primary studies are available on the magnitude of adherence to option B plus and factors associated in Eastern African countries, they do not provide strong evidence in helping policymakers to address suboptimal adherence to option B plus. Therefore, this systematic review and meta-analysis was intended to estimate the pooled magnitude of adherence to option B plus program and associated factors among women in Eastern African countries.
PubMed, Medline, HINARI, Cochrane library, the Web of Science, and Google Scholar were searched for studies reported on the magnitude of adherence to option B plus among women in Eastern African countries. The search terms used were "option B plus", "magnitude", "prevalence", "PMTCT", "ART adherence", "associated factors", "all lists of Eastern African countries" and their combination by Boolean operators. The effect sizes of the meta-analysis were the magnitude of adherence to option B plus and the odds ratio of the associated factors. STATA/SE V14 was used for statistical analysis, and publication bias was assessed using funnel plots and Egger's test.
Fourteen studies having total participants of 4883 were included in the systematic review and meta-analysis. Using the random effect model, the pooled prevalence of adherence to option B plus was 71.88% (95% CI: 58.54-85.23%). The factors associated with good adherence to option B plus PMTCT program were partner support (Adjusted odds ratio (AOR) = 4.13; 95% CI: 2.78-6.15), received counseling services (AOR = 4.12, 95% CI: 2.81-6.02), disclosure of HIV status to partner (AOR = 4.38; 95% CI: 1.79-10.70), and clinical stage of HIV/AIDS I/II (AOR = 2.62; 95% CI: 1.53-4.46).
The level of adherence to option B plus program in Eastern African countries was generally sub-optimal. Thus, a coordinated effort is needed to raise the number of mothers to be tested, and early treatment initiation for HIV positive mothers before the disease advances. Furthermore, counseling services for couples on the importance of early treatment initiation and adherence to medications must be given due attention.
尽管预防母婴传播（PMTCT）服务已覆盖且有诸多益处，但母亲对“选项B+”方案的依从性仍是一项挑战。虽然在东非国家，关于“选项B+”方案依从性程度及相关因素的初步研究较少，且这些研究未能为政策制定者解决“选项B+”方案依从性欠佳的问题提供有力证据。因此，本系统评价和荟萃分析旨在估计东非国家女性对“选项B+”方案的合并依从性程度及相关因素。
在PubMed、Medline、HINARI、Cochrane图书馆、科学网和谷歌学术中检索关于东非国家女性对“选项B+”方案依从性程度的研究报告。使用的检索词为“选项B+”“程度”“患病率”“预防母婴传播”“抗逆转录病毒治疗依从性”“相关因素”“所有东非国家列表”，并通过布尔运算符对其进行组合。荟萃分析的效应量为对“选项B+”方案的依从性程度及相关因素的比值比。使用STATA/SE V14进行统计分析，并通过漏斗图和埃格检验评估发表偏倚。
14项研究共纳入4883名参与者，纳入了本系统评价和荟萃分析。采用随机效应模型，对“选项B+”方案的合并依从率为71.88%（95%置信区间：58.54 - 85.23%）。与良好依从“选项B+”预防母婴传播方案相关的因素包括伴侣支持（调整后的比值比（AOR）= 4.13；95%置信区间：2.78 - 6.15）、接受咨询服务（AOR = 4.12，95%置信区间：2.81 - 6.02）、向伴侣披露HIV感染状况（AOR = 4.38；95%置信区间：1.79 - 10.70）以及HIV/AIDS I/II临床分期（AOR = 2.62；95%置信区间：1.53 - 4.46）。
东非国家对“选项B+”方案的依从水平总体欠佳。因此，需要共同努力增加接受检测的母亲数量，并在HIV阳性母亲病情进展前尽早开始治疗。此外，必须重视为夫妻提供关于尽早开始治疗和坚持用药重要性的咨询服务。
