Stanton Amelia M, Blyler Abigail P, Mosery Nzwakie, Goodman Georgia R, Vanderkruik Rachel, Sithole Kedibone, Bedoya C Andres, Smit Jennifer, Psaros Christina
Boston University.
University of Pennsylvania.
Res Sq. 2023 Jan 20:rs.3.rs-2463315. doi: 10.21203/rs.3.rs-2463315/v1.
Background COVID-19 and efforts to manage widespread infection may compromise HIV care engagement. The COVID-19-related factors linked to reduced HIV engagement have not been assessed among postpartum women with HIV, who are at heightened risk of attrition under non-pandemic circumstances. To mitigate the effects of the pandemic on care engagement and to prepare for future public health crises, it is critical to understand how COVID-19 has impacted (1) engagement in care and (2) factors that may act as barriers to care engagement. Methods A quantitative assessment of COVID-19-related experiences was added to a longitudinal cohort study assessing predictors of postpartum attrition from HIV care among women in South Africa. Participants (N = 266) completed the assessment at 6, 12, 18, or 24 months postpartum between June and November of 2020. Those who endorsed one or more challenge related to engagement in care (making or keeping HIV care appointments, procuring HIV medications, procuring contraception, and/or accessing immunization services for infants; n = 55) were invited to complete a brief qualitative interview, which explored the specific factors driving these challenges, as well as other impacts of COVID-19 on care engagement. Within this subset, 53 participants completed an interview; qualitative data were analyzed via rapid analysis. Results Participants described key challenges that reduced their engagement in HIV care and identified four other domains of COVID-19-related impacts: physical health, mental health, relationship with a partner or with the father of the baby, and motherhood/caring for the new baby. Within these domains, specific themes and subthemes emerged, with some positive impacts of COVID-19 also reported (e.g., increased quality time, improved communication with partner, HIV disclosure). Coping strategies for COVID-19-related challenges (e.g., acceptance, spirituality, distraction) were also discussed. Conclusions About one in five participants reported challenges accessing HIV care, medications, or services, and they faced complex, multilayered barriers to remaining engaged. Physical health, mental health, relationships with partners, and ability to care for their infant were also affected. Given the dynamic nature of the pandemic and general uncertainty about its course, ongoing assessment of pandemic-related challenges among postpartum women is needed to avoid HIV care disruptions and to support wellbeing.
新冠疫情以及应对广泛感染的措施可能会影响艾滋病毒护理服务的参与度。在非疫情情况下就有较高流失风险的感染艾滋病毒的产后妇女中，尚未评估与艾滋病毒护理服务参与度降低相关的新冠疫情因素。为减轻疫情对护理服务参与度的影响，并为未来的公共卫生危机做好准备，了解新冠疫情如何影响（1）护理服务参与度以及（2）可能成为护理服务参与障碍的因素至关重要。方法：在一项纵向队列研究中增加了对新冠疫情相关经历的定量评估，该研究评估南非妇女产后艾滋病毒护理流失的预测因素。参与者（N = 266）在2020年6月至11月期间产后6、12、18或24个月完成了评估。那些认可一项或多项与护理服务参与度相关挑战的人（进行或预约艾滋病毒护理、获取艾滋病毒药物、获取避孕措施和/或为婴儿提供免疫服务；n = 55）被邀请完成一次简短的定性访谈，该访谈探讨了导致这些挑战的具体因素以及新冠疫情对护理服务参与度的其他影响。在这个子集中，53名参与者完成了访谈；通过快速分析对定性数据进行了分析。结果：参与者描述了降低他们艾滋病毒护理服务参与度的关键挑战，并确定了新冠疫情相关影响的其他四个领域：身体健康、心理健康、与伴侣或婴儿父亲的关系以及母亲身份/照顾新生儿。在这些领域中，出现了具体的主题和子主题，也报告了新冠疫情的一些积极影响（例如，增加了有质量的相处时间、改善了与伴侣的沟通、艾滋病毒信息披露）。还讨论了应对新冠疫情相关挑战的策略（例如，接受、精神寄托、转移注意力）。结论：约五分之一的参与者报告在获取艾滋病毒护理、药物或服务方面存在挑战，并且他们在继续参与护理服务方面面临复杂、多层次的障碍。身体健康、心理健康、与伴侣的关系以及照顾婴儿的能力也受到了影响。鉴于疫情的动态性质及其发展过程的普遍不确定性，需要持续评估产后妇女中与疫情相关的挑战，以避免艾滋病毒护理中断并支持她们的健康。
