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埃塞俄比亚艾滋病毒阳性女性对B+预防母婴传播方案的依从性及其预测因素。一项系统评价和荟萃分析。

Adherence to option B+ PMTCT program and its predictors among HIV-positive women in Ethiopia. A systematic review and meta-analysis.

作者信息

Geremew Habtamu, Geremew Demeke, Abdisa Samuel, Dessie Anteneh Mengist, Kassa Getachew Mullu, Moges Nurilign Abebe

机构信息

College of Health Sciences Oda Bultum University Chiro Ethiopia.

Department of Medical Laboratory Sciences, Immunology and Molecular Biology Unit, College of Medicine and Health Sciences Bahir Dar University Bahir Dar Ethiopia.

出版信息

Health Sci Rep. 2023 Jul 5;6(7):e1404. doi: 10.1002/hsr2.1404. eCollection 2023 Jul.

Abstract

BACKGROUND

Previously, few studies investigated level of adherence to option B+ lifelong antiretroviral therapy (ART) in Ethiopia. However, their findings were inconsistent. Therefore, this review aimed to determine the pooled magnitude of adherence to option B+ lifelong ART and its predictors among human immune virus (HIV)-positive women in Ethiopia.

METHODS

A comprehensive web-based search was conducted using PubMed, Cochrane Library, Science Direct, Google scholar, and African Journals Online databases to retrieve relevant articles. STATA 14 statistical software was used to carry out the meta-analysis. We used the random effects model to account for the large heterogeneity across included studies. Egger's regression test in conjunction with funnel plot and statistics were utilized to assess publication bias and heterogeneity among included studies respectively.

RESULT

Twelve studies with a total of 2927 study participants were involved in this analysis. The pooled magnitude of adherence to option B+ lifelong ART was 80.72% (95% confidence interval [CI]: 77.05-84.39;  = 85.4%). Disclosure of sero-status (OR 2.58 [95% CI: 1.55-4.3]), receiving counseling (OR 4.93 [95% CI: 3.21-7.57]), attending primary school and above (OR 2.45 [95% CI: 1.31-4.57]), partner support (OR 2.24 [95% CI: 1.11, 4.52]), good knowledge about prevention of mother-to-child transmission (PMTCT) (OR 4.22 [95% CI: 2.02-8.84]), taking less time to reach health facility (OR 1.64 [95% CI: 1.13-2.4]), and good relation with care provider (OR 3.24 [95% CI: 1.96-5.34]) were positively associated with adherence. Whereas, fear of stigma and discrimination (OR 0.12 [95% CI: 0.06-0.22]) and advanced disease stage (OR 0.59 [95% CI: 0.37-0.92]) were negatively associated.

CONCLUSION

The level of adherence to option B+ lifelong ART was suboptimal. Strengthened comprehensive counseling and client education on PMTCT, HIV status disclosure, and male partner involvement are important to eliminate mother to child transmission and control the pandemic.

摘要

背景

此前,在埃塞俄比亚,很少有研究调查对B+方案终身抗逆转录病毒疗法(ART)的依从性水平。然而,他们的研究结果并不一致。因此,本综述旨在确定埃塞俄比亚感染人类免疫病毒(HIV)的女性中对B+方案终身ART的综合依从程度及其预测因素。

方法

通过PubMed、Cochrane图书馆、科学Direct、谷歌学术和非洲期刊在线数据库进行全面的基于网络的搜索,以检索相关文章。使用STATA 14统计软件进行荟萃分析。我们使用随机效应模型来考虑纳入研究之间的巨大异质性。分别利用Egger回归检验结合漏斗图和I²统计量来评估纳入研究中的发表偏倚和异质性。

结果

本分析纳入了12项研究,共有2927名研究参与者。对B+方案终身ART的综合依从程度为80.72%(95%置信区间[CI]:77.05 - 84.39;I² = 85.4%)。血清学状态披露(比值比[OR] 2.58 [95% CI:1.55 - 4.3])、接受咨询(OR 4.93 [95% CI:3.21 - 7.57])、接受小学及以上教育(OR 2.45 [95% CI:1.31 - 4.57])、伴侣支持(OR 2.24 [95% CI:1.11, 4.52])、对预防母婴传播(PMTCT)有良好认知(OR 4.22 [95% CI:2.02 - 8.84])、到达医疗机构所需时间较短(OR 1.64 [95% CI:1.13 - 2.4])以及与医护人员关系良好(OR 3.24 [95% CI:1.96 - 5.34])与依从性呈正相关。而对耻辱和歧视的恐惧(OR 0.12 [95% CI:0.06 - 0.22])和疾病晚期(OR 0.59 [95% CI:0.37 - 0.92])与依从性呈负相关。

结论

对B+方案终身ART的依从水平不理想。加强关于PMTCT、HIV状态披露和男性伴侣参与的综合咨询及客户教育对于消除母婴传播和控制疫情很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2aa3/10323164/36c559070283/HSR2-6-e1404-g001.jpg

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