Getaneh Temesgen, Negesse Ayenew, Dessie Getenet
Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
HIV AIDS (Auckl). 2021 Aug 28;13:851-859. doi: 10.2147/HIV.S314306. eCollection 2021.
Human immunodeficiency virus-infected children share the highest risk of death compared with all other age groups, and more than 90% of this viral infection of children was accounted for by transmission from mother to infant. This rate can be prevented and reduced with implementation of option B+ effectively. However, unacceptably high lost follow-up of mothers highly affected the effectiveness of this program. In Ethiopia, only 71% of mothers were adherent on their follow-up. So, this study was aimed to understand the reasons and experiences of lost follow-up of mothers under the prevention of mother to child transmission (option B+) program in North West Ethiopia.
A qualitative study using a case study design was carried out using in-depth interviews among 20 mothers who had started the option B+ treatment protocol but discontinued their follow-up for more than two months, and 6 key informants and individuals who were engaged in management and control of human immunodeficiency virus at Woreda and Zonal level. An unstructured interview guide was used and translated into the local language. Study participants were selected using purposive sampling technique. After written consent was obtained, all study participants' interviews were audio-recorded and analyzed using deductive content analysis.
A total of 26 mothers participated in this study. Accordingly, the most frequently raised reasons were lack of formal education which affects income level, lack of disclosure, lack of partner and family support, absence of male involvement and stigma-discrimination. But, unavailability of option B+ regimens in the nearest health facility or long distance from health facility, discordance and lack of experienced professionals in terms of counseling during initiation were also essential reasons.
Educational and economic empowerment intervention (particularly for vulnerable households), promoting family support and male involvement, active counseling at initiation and during follow up and community level awareness improvement should be addressed to increase option B+ regimen adherence and retention.
与所有其他年龄组相比，感染人类免疫缺陷病毒的儿童死亡风险最高，且儿童感染这种病毒的情况中超过90%是由母婴传播所致。通过有效实施B+方案可预防和降低这一比率。然而，母亲随访失访率高得令人无法接受，严重影响了该方案的效果。在埃塞俄比亚，只有71%的母亲坚持接受随访。因此，本研究旨在了解埃塞俄比亚西北部预防母婴传播（B+方案）项目中母亲随访失访的原因及经历。
采用案例研究设计进行定性研究，对20名已开始B+治疗方案但随访中断超过两个月的母亲，以及6名在县和地区层面从事人类免疫缺陷病毒管理与控制工作的关键信息提供者和个人进行深入访谈。使用了一份非结构化访谈指南，并翻译成当地语言。采用目的抽样技术选取研究参与者。获得书面同意后，对所有研究参与者的访谈进行录音，并使用演绎性内容分析法进行分析。
共有26名母亲参与了本研究。相应地，最常提出的原因包括缺乏正规教育影响收入水平、缺乏信息披露、缺乏伴侣和家庭支持、男性未参与以及耻辱 - 歧视。但是，最近的医疗机构没有B+治疗方案或距离医疗机构较远，以及在开始治疗时咨询方面不一致和缺乏经验丰富的专业人员也是重要原因。
应开展教育和经济赋权干预（特别是针对弱势家庭），促进家庭支持和男性参与，在开始治疗和随访期间积极提供咨询，并提高社区层面的认识，以提高B+治疗方案的依从性和保留率。
