肯尼亚 HIV 阳性孕妇和产后妇女队列中晚期抗逆转录病毒药物续药和无保护性行为。

Late antiretroviral refills and condomless sex in a cohort of HIV-seropositive pregnant and postpartum Kenyan women.

机构信息

Departments of Medicine, University of Washington, Seattle, Washington, United States of America.

Global Health, University of Washington, Seattle, Washington, United States of America.

出版信息

PLoS One. 2021 Jul 19;16(7):e0254767. doi: 10.1371/journal.pone.0254767. eCollection 2021.

DOI:10.1371/journal.pone.0254767

PMID:34280229

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8289061/

Abstract

INTRODUCTION: The postpartum period can be challenging for women living with HIV. Understanding how the postpartum period impacts ART adherence and condomless sex could inform the development of comprehensive sexual and reproductive health and HIV services tailored to the needs of women living with HIV during this critical interval. METHODS: In a longitudinal cohort study of HIV-seropositive Kenyan women, late ART refills and self-reported condomless sex were compared between the woman's pregnancy and the postpartum period. Analyses were conducted using generalized estimating equations and adjusted for alcohol use, depressive symptoms, intimate partner violence (IPV), and having a recent regular partner. Effect modification was explored for selected variables. RESULTS AND DISCUSSION: 151 women contributed visits. Late ART refills occurred at 7% (32/439) of pregnancy visits compared to 18% (178/1016) during the postpartum period (adjusted relative risk [aRR] 2.44, 95% confidence interval [CI] 1.62-3.67). This association differed by women's education level. Women with ≥8 years of education had late ART refills more during the postpartum period than pregnancy (aRR 3.00, 95%CI 1.95-4.62). In contrast, in women with <8 years of education, late ART refills occurred similarly during pregnancy and the postpartum period (aRR 0.88, 95%CI 0.18-4.35). Women reported condomless sex at 10% (60/600) of pregnancy visits compared to 7% (72/1081) of postpartum visits (aRR 0.76, 95%CI 0.45-1.27). This association differed by whether women had experienced recent IPV. Women without recent IPV had a significant decline in condomless sex from pregnancy to postpartum (aRR 0.53, 95%CI 0.30-0.95) while women with recent IPV had no significant change in condomless sex from pregnancy to postpartum (aRR 1.76, 95%CI 0.87-3.55). CONCLUSION: Improved support for ART adherence during the postpartum period and addressing IPV to limit condomless sex could improve HIV treatment and prevention outcomes for HIV-seropositive women as well as their infants and sexual partners.

摘要

引言：对于感染 HIV 的女性来说，产后阶段可能极具挑战性。了解产后阶段对 ART 服药依从性和无保护性行为的影响，可以为制定综合的性健康和生殖健康以及 HIV 服务提供信息，这些服务针对的是 HIV 阳性女性在这一关键时期的需求。

方法：在一项针对肯尼亚 HIV 阳性女性的纵向队列研究中，比较了女性怀孕和产后期间 ART 延迟补充和自我报告的无保护性行为。使用广义估计方程进行分析，并调整了酒精使用、抑郁症状、亲密伴侣暴力（IPV）和最近有固定性伴侣的因素。探索了选定变量的效应修饰作用。

结果与讨论：151 名女性参与了研究。在怀孕就诊中，ART 延迟补充的比例为 7%（32/439），而在产后就诊中，ART 延迟补充的比例为 18%（178/1016）（调整后的相对风险 [aRR] 2.44，95%置信区间 [CI] 1.62-3.67）。这种关联因女性的教育程度而异。接受过≥8 年教育的女性在产后阶段比怀孕阶段更有可能出现 ART 延迟补充（aRR 3.00，95%CI 1.95-4.62）。相比之下，接受过<8 年教育的女性在怀孕和产后阶段出现 ART 延迟补充的情况相似（aRR 0.88，95%CI 0.18-4.35）。在怀孕就诊中，有 10%（60/600）的女性报告了无保护性行为，而在产后就诊中，有 7%（72/1081）的女性报告了无保护性行为（aRR 0.76，95%CI 0.45-1.27）。这种关联因女性最近是否经历过 IPV 而有所不同。没有近期经历过 IPV 的女性从怀孕到产后无保护性行为的比例显著下降（aRR 0.53，95%CI 0.30-0.95），而最近经历过 IPV 的女性从怀孕到产后无保护性行为的比例没有显著变化（aRR 1.76，95%CI 0.87-3.55）。

结论：在产后阶段加强对 ART 服药依从性的支持，并解决 IPV 问题以限制无保护性行为，可以改善 HIV 阳性女性及其婴儿和性伴侣的 HIV 治疗和预防效果。