Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Infectious Disease Institute, Kampala, Uganda.
BMC Public Health. 2020 Dec 7;20(1):1883. doi: 10.1186/s12889-020-09991-w.
Despite concerns about dolutegravir use in pregnancy, most low- and middle-income countries are accelerating the introduction of dolutegravir-based regimens into national antiretroviral treatment programmes. Questions remain about the acceptability of dolutegravir use in women due to the potential risks in pregnancy. This study from South Africa and Uganda explored community values, preferences and attitudes towards the use of dolutegravir-based regimens in women.
This study employed a qualitative design involving in-depth interviews and focus group discussion conducted between August 2018 to March 2019. The study was conducted in the months following an announcement of a potential risk for neural tube defects with dolutegravir use among women during conception and the first trimester. Participants included HIV positive pregnant and lactating women and their partners. They were selected purposively from urban poor communities in South Africa and Uganda. Data was analysed thematically in NVivo.
Forty-four in-depth interviews and 15 focus group discussions were conducted. Most participants had positive views of dolutegravir-based regimens and perceived it to be more desirable compared with efavirenz-containing regimens. There was widespread concern about use of dolutegravir during pregnancy and among women of childbearing age due to publicity around the possible association with neural tube defects. Acceptability was gendered, with nearly all male participants preferring their female spouses of childbearing potential not to use dolutegravir, while most women not planning pregnancy wanted access to contraception alongside dolutegravir. Community awareness and knowledge of dolutegravir was low and characterised by negative information. Women were concerned about HIV-related stigma and wanted the privacy features of dolutegravir to be strengthened with modification of the pill appearance and disguised packaging.
Dolutegravir-based regimens were found to be generally acceptable for use in women except during pregnancy. Interest in a dolutegravir-based regimen was linked with its perceived potential to enhance health, privacy and reduce stigma while concerns about neural tube defects were the main potential barrier to dolutegravir uptake in women. In order to optimise the community acceptability and uptake of acceptability-based regimen among women it is critical to strengthen community awareness and understanding of dolutegravir treatment, improve contraception services alongside the introduction of dolutegravir, and engage with male partners.
尽管人们对孕期使用多替拉韦有所担忧，但大多数中低收入国家正在加速将多替拉韦方案纳入国家抗逆转录病毒治疗方案。由于多替拉韦在孕期可能存在风险，因此，关于女性对多替拉韦的可接受性问题仍存在疑问。本项来自南非和乌干达的研究旨在探索社区对多替拉韦方案在女性中的使用的价值观、偏好和态度。
本研究采用定性设计，包括 2018 年 8 月至 2019 年 3 月期间进行的深入访谈和焦点小组讨论。该研究是在宣布多替拉韦在受孕和妊娠早期使用可能导致神经管缺陷的潜在风险之后的几个月内进行的。参与者包括艾滋病毒阳性孕妇和哺乳期妇女及其伴侣。他们是从南非和乌干达城市贫困社区中有意选择的。使用 NVivo 对数据进行了主题分析。
共进行了 44 次深入访谈和 15 次焦点小组讨论。大多数参与者对多替拉韦方案持积极看法，并认为与含依非韦伦方案相比，多替拉韦方案更理想。由于有关多替拉韦可能与神经管缺陷有关的宣传，几乎所有男性参与者都担心女性在孕期和育龄期使用多替拉韦，而大多数不打算怀孕的女性则希望在使用多替拉韦的同时获得避孕措施。社区对多替拉韦的认识和了解程度较低，且以负面信息为特征。妇女担心与艾滋病毒相关的耻辱感，并希望通过改变药丸外观和伪装包装来加强多替拉韦的隐私功能。
除了孕期外，多替拉韦方案在女性中通常被认为是可以接受的。对多替拉韦方案的兴趣与它被认为可以潜在提高健康水平、保护隐私和减少耻辱感有关，而对神经管缺陷的担忧是多替拉韦在女性中使用的主要潜在障碍。为了提高社区对女性基于可接受性方案的接受度和采用度，必须加强社区对多替拉韦治疗的认识和理解，在引入多替拉韦的同时改善避孕服务，并与男性伴侣合作。
