在乌干达中部，是什么因素影响了 HIV 阳性孕妇和哺乳期妇女采用 Option B+（终生抗逆转录病毒疗法）及其早期坚持？一项混合方法研究。

What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.

机构信息

Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.

出版信息

PLoS One. 2021 May 5;16(5):e0251181. doi: 10.1371/journal.pone.0251181. eCollection 2021.

DOI:10.1371/journal.pone.0251181

PMID:33951109

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8099116/

Abstract

BACKGROUND

High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda.

METHODS

A mixed approaches study was carried out in six health facilities in Masaka, Mityana, and Luwero districts from October 2013 to February 2016. Questionnaires were administered to 507 HIV positive pregnant females seeking antenatal care services. Key informant interviews were conducted with 54 health providers, and in-depth interviews (IDIs) with 57 HIV positive women on Option B+ ART. Quantitative data were analyzed using log-binomial regression model to determine factors associated with optimal adherence (taking at least 95% of the prescribed ART), while thematic analysis was used on qualitative data.

RESULTS

Ninety one percent of women (463/507) received a prescription of life long ART. Of these, 93.3% (432/463) started swallowing their medicines. Overall, 83% of women who received ART prescriptions (310/374) felt they were ready to initiate ART immediately. Main motivating factors to swallow ART among those who received a prescription were women's personal desire to be healthy (92.3%) and desire to protect their babies (90.6%). Optimal adherence to ART was achieved by 76.8% (315/410). Adherence was higher among females who were ready to start ART (adj. PR = 3.20; 95% CI: 1.15-8.79) and those who had revealed their HIV positive result to someone (adj. PR = 1.23; 95% CI: 1.04-1.46). Facilitators of ART uptake from qualitative findings included adequate counseling, willingness to start, and knowing the benefits of ART. Reasons for refusal to start ART included being unready to start ART, fear to take ART for life, doubt of HIV positive results, and preference for local herbs. Reasons for non-adherence were travelling far away from health facilities, fear of side effects, non-disclosure of HIV results to anyone, and perception that the baby is safe from HIV infection post-delivery.

CONCLUSIONS

Uptake of Option B+ ART was very high. However, failure to start swallowing ART and sub-optimal adherence are a major public health concern. Enhancing women's readiness to start ART and encouraging HIV result revelation could improve ART uptake and adherence.

摘要

背景

高吸收率和最佳依从性的 B 方案+抗逆转录病毒疗法（ART）可提高母婴 HIV 传播的预防效果。需要在乌干达中部评估 B 方案+ART 的吸收率、早期依从性和相关因素。

方法

2013 年 10 月至 2016 年 2 月，在马萨卡、米蒂亚纳和卢韦罗地区的六家卫生机构进行了一项混合方法研究。对 507 名寻求产前保健服务的 HIV 阳性孕妇进行了问卷调查。对 54 名卫生工作者进行了关键知情人访谈，并对 57 名接受 B 方案+ART 的 HIV 阳性妇女进行了深入访谈。采用对数二项式回归模型对定量数据进行分析，以确定与最佳依从性（至少服用 95%规定的 ART）相关的因素，同时对定性数据进行主题分析。

结果

91%的妇女（463/507）获得了终生 ART 处方。其中，93.3%（432/463）开始服用药物。总体而言，接受 ART 处方的妇女中有 83%（310/374）表示她们准备立即开始接受 ART。收到处方后愿意服用 ART 的主要动机因素是妇女个人希望健康（92.3%）和希望保护婴儿（90.6%）。410 名接受 ART 处方的妇女中，有 76.8%（315/410）实现了最佳依从性。准备开始 ART 的女性（调整后比值比 [aPR] = 3.20；95%置信区间：1.15-8.79）和向他人透露 HIV 阳性结果的女性（aPR = 1.23；95%CI：1.04-1.46）的依从性更高。从定性研究中发现的 ART 吸收率的促进因素包括充分的咨询、愿意开始和了解 ART 的益处。拒绝开始 ART 的原因包括尚未准备好开始 ART、担心终生服用 ART、对 HIV 阳性结果的怀疑以及偏爱当地草药。不依从的原因包括远离卫生机构、担心副作用、未向任何人透露 HIV 结果，以及认为婴儿分娩后不会感染 HIV。