撒哈拉以南非洲地区孕妇和哺乳期妇女坚持选择 B+抗逆转录病毒疗法及相关因素：系统评价和荟萃分析。

BACKGROUND: To assess the adherence to option B + antiretroviral therapy (ART) and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa (SSA). METHODS: We conducted a comprehensive search from 01 January 2012 to 03 October 2022, across four databases: PubMed, Scopus, Proquest Central, and Index Medicus Africain, to identify studies focused on pregnant and/or breastfeeding women living with HIV and receiving option B+ ART in SSA. Studies reporting adherence data were included in the meta-analysis. Were excluded studies published before 01 January 2012, grey literature, systematic reviews, and meta-analysis studies. Articles selection and data extraction were performed independently by two reviewers. We evaluated pooled adherence and pooled association between various factors and adherence using a random-effects model. RESULTS: Overall, 42 studies involving 15,158 participants across 15 countries contributed to the meta-analysis. The overall pooled adherence was 72.3% (95% CI: 68.2-76.1%). Having high education level (pooled odds ratio (OR): 2.25; 95% CI: 1.57-3.21), living in urban area (pooled OR: 1.75; 95% CI: 1.10-2.81), disclosing status to a family/partner (pooled OR: 1.74; 95% CI: 1.27-2.40), having a support system (pooled OR: 3.19; 95% CI: 1.89-5.36), receiving counseling (pooled OR: 3.97; 95% CI: 2.96-5.34), initiating ART at early clinical HIV stage (pooled OR: 2.22; 95% CI: 1.08-4.56), and having good knowledge on PMTCT/HIV (pooled OR: 2.71; 95% CI: 1.40-5.25) were factors significantly associated with adherence to option B + ART. CONCLUSIONS: Despite the implementation of option B+ ART, the level of adherence among pregnant and breastfeeding women in SSA falls short of meeting the critical thresholds for viral load suppression as outlined in the 95-95-95 objectives set for 2025. These objectives are integral for achieving HIV elimination, and in turn, preventing HIV mother-to-child transmission. To bridge this gap, urgent tailored interventions based on individual and structural factors are essential to enhance adherence within these subgroups of women. This targeted approach is crucial in striving towards the HIV elimination target in SSA.

背景：评估撒哈拉以南非洲（SSA）中妊娠和哺乳期妇女坚持 B 方案+抗逆转录病毒疗法（ART）的情况及其相关因素。

方法：我们从 2012 年 1 月 1 日至 2022 年 10 月 3 日，在四个数据库（PubMed、Scopus、Proquest Central 和 Index Medicus Africain）中进行了全面检索，以确定专注于 HIV 感染的妊娠和/或哺乳期妇女并接受 B 方案+ART 的 SSA 地区的研究。纳入报告了依从性数据的研究进行荟萃分析。排除了发表于 2012 年 1 月 1 日之前的研究、灰色文献、系统评价和荟萃分析研究。两名评审员独立进行了文章选择和数据提取。我们使用随机效应模型评估了各种因素与依从性之间的总体依从性和相关性。

结果：共有来自 15 个国家的 42 项研究，涉及 15158 名参与者，纳入荟萃分析。总体依从率为 72.3%（95%CI：68.2-76.1%）。具有较高教育水平（合并优势比（OR）：2.25；95%CI：1.57-3.21）、居住在城市地区（合并 OR：1.75；95%CI：1.10-2.81）、向家人/伴侣披露身份（合并 OR：1.74；95%CI：1.27-2.40）、获得支持系统（合并 OR：3.19；95%CI：1.89-5.36）、接受咨询（合并 OR：3.97；95%CI：2.96-5.34）、早期临床 HIV 阶段开始接受 ART（合并 OR：2.22；95%CI：1.08-4.56）以及对 PMTCT/HIV 有良好认识（合并 OR：2.71；95%CI：1.40-5.25）是与 B 方案+ART 依从性显著相关的因素。

结论：尽管实施了 B 方案+ART，但 SSA 妊娠和哺乳期妇女的依从水平仍未达到 2025 年 95-95-95 目标中规定的病毒载量抑制的关键阈值。这些目标是实现 HIV 消除并进而预防母婴传播的关键。为了弥补这一差距，迫切需要针对个体和结构因素制定有针对性的干预措施，以提高这些妇女亚组的依从性。这种有针对性的方法对于努力实现 SSA 的 HIV 消除目标至关重要。