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HIV 适应性群体产前护理:评估病毒抑制和产后护理保留情况。

HIV-Adapted Group Prenatal Care: Assessing Viral Suppression and Postpartum Retention in Care.

机构信息

Department of Maternal Fetal Medicine and Baylor College of Medicine, Houston, Texas, USA.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.

出版信息

AIDS Patient Care STDS. 2021 Feb;35(2):39-46. doi: 10.1089/apc.2020.0249.

Abstract

Viral suppression and postpartum retention in care have far-reaching health implications for pregnant women living with HIV and their children, yet remain public health challenges. Prenatal care presents a unique opportunity to engage pregnant women in care. The purpose of this study is to evaluate whether group prenatal care is effective in impacting these outcomes for pregnant women living with HIV. A retrospective cohort study was performed of all women living with HIV who obtained prenatal care from a community-based health center between 2013 and 2019. Women who spoke English or Spanish, remained within the system, and had not participated in group prenatal care previously were included. Women self-selected a prenatal care model: 85 selected group care and 109 elected individual care. Group prenatal care followed a standard Centering Pregnancy curriculum with the addition of HIV-related topics. The primary outcomes of the study were viral suppression (viral load <20 copies/mL) and postpartum retention in care (attending at least one or two visits with HIV primary care within 12 months postpartum). After adjusting for potential confounding factors, women who participated in group prenatal care were significantly more likely to have at least one HIV primary care visit postpartum {adjusted odds ratio (aOR) = 2.71 [95% confidence interval (CI 1.14-6.46)];  = 0.024}, and had a trend for achieving viral suppression by the time of delivery [aOR = 2.29 (95% CI 0.94-5.55);  = 0.068]. We have demonstrated that group prenatal care for pregnant women living with HIV is feasible and effective, with positive impacts on retention in care and viral suppression, factors that affect long-term outcomes from patients living with HIV.

摘要

病毒抑制和产后持续护理对感染艾滋病毒的孕妇及其子女的健康有深远影响,但仍是公共卫生挑战。产前护理为孕妇提供了一个独特的参与护理的机会。本研究旨在评估群体产前护理是否能有效影响感染艾滋病毒的孕妇的这些结局。本研究对 2013 年至 2019 年间在一家社区健康中心接受产前护理的所有感染艾滋病毒的妇女进行了回顾性队列研究。纳入的妇女需讲英语或西班牙语、留在系统内、且以前未参加过群体产前护理。妇女自行选择产前护理模式:85 名选择群体护理,109 名选择个体护理。群体产前护理遵循标准的 Centering Pregnancy 课程,增加了与艾滋病毒相关的主题。本研究的主要结局是病毒抑制(病毒载量<20 拷贝/mL)和产后持续护理(产后 12 个月内至少有一次或两次艾滋病毒初级保健就诊)。在调整潜在混杂因素后,参加群体产前护理的妇女产后至少有一次艾滋病毒初级保健就诊的可能性显著更高(调整后的优势比[aOR] = 2.71 [95%置信区间(CI)1.14-6.46]; = 0.024),并且在分娩时实现病毒抑制的趋势更大[aOR = 2.29(95% CI 0.94-5.55); = 0.068]。我们已经证明,为感染艾滋病毒的孕妇提供群体产前护理是可行和有效的,对护理保留和病毒抑制有积极影响,这些因素会影响感染艾滋病毒患者的长期结局。

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