Nhampossa Tacilta, Torres Neusa, Chivangue Mariza, Chauque Celia, Mazuze Maura, Mendes-Muxlhanga Anete, Alonso Yara, Enguita-FernàndezAnete Cristina, Gonzalez Raquel, Sevene Esperança, Munguambe Khatia, Menendez Clara
Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique.
Instituto Nacional de Saúde (INS), Ministério de Saúde, Maputo, Mozambique.
BMC Public Health. 2025 May 2;25(1):1633. doi: 10.1186/s12889-025-22644-0.
HIV-infected pregnant women (HIVPW) are especially susceptible to malaria infection. However, HIVPW cannot receive the recommended malaria Intermittent Preventive Treatment (IPTp) with sulphadoxine-pyrimethamine due to potential adverse reactions with cotrimoxazole, which is given to HIV-infected individuals to prevent opportunistic infections. Within the scope of a clinical trial to evaluate the safety and efficacy of dihydroartemisinin-piperaquine (DHA-PPQ) as IPTp in HIVPW, we aimed to explore pregnant women's acceptability of DHA-PPQ in the Manhiça District Hospital, Mozambique.
A qualitative study was conducted from December-2019 to October-2020 including 44 HIVPW participating in the clinical trial, 35 HIV-uninfected pregnant women attending the antenatal care clinic and eight health care providers (HCPs). Information was obtained through semi-structured and in-depth interviews. The interviews were recorded, transcribed, coded, and a combination of content and thematic analysis was performed.
All the HIVPW took monthly doses of DHA-PPQ until delivery. They stated that the main motivation for accepting DHA-PPQ was the belief that guidance from healthcare providers should not be refused. Despite some HIVPW reporting vertigo, vomiting, and malaise after taking DHA-PPQ, they expressed willingness to use it in a future pregnancy, believing it contributed to a healthy outcome. Pregnant women and HCPs indicated that factors supporting DHA-PPQ acceptability include information on the benefits of IPTp, testimonials from women who have previously taken DHA-PPQ, and home delivery of DHA-PPQ by HCPs. The perception that home dispensing of DHA-PPQ (a medication administered only for HIVPW) could affect measures taken to ensure HIV-infection confidentiality was not found to be a potential barrier to DHA-PPQ acceptability when delivered in HIVPW's homes.
The acceptability of DHA-PPQ among HIVPW appears to be influenced more by trust in healthcare providers rather than by the perceived benefits of the medication itself. Leveraging this trust to enhance awareness and understanding of DHA-PPQ's benefits could further improve its acceptability. Moreover, further implementation research focused on acceptability in a real-world environment is essential to deepen the understanding of DHA-PPQ acceptability beyond the clinical trial setting, and inform policy decisions accordingly.
感染艾滋病毒的孕妇（HIVPW）特别容易感染疟疾。然而，由于与复方新诺明存在潜在不良反应，HIVPW不能接受推荐的用周效磺胺 - 乙胺嘧啶进行疟疾间歇性预防性治疗（IPTp），复方新诺明是用于预防艾滋病毒感染者机会性感染的药物。在一项评估双氢青蒿素 - 哌喹（DHA - PPQ）作为HIVPW的IPTp的安全性和有效性的临床试验范围内，我们旨在探讨莫桑比克曼希卡区医院孕妇对DHA - PPQ的接受程度。
于2019年12月至2020年10月进行了一项定性研究，包括44名参与临床试验的HIVPW、35名到产前护理诊所就诊的未感染艾滋病毒的孕妇以及8名医护人员（HCP）。通过半结构化和深入访谈获取信息。访谈进行了录音、转录、编码，并进行了内容分析和主题分析相结合的分析。
所有HIVPW每月服用DHA - PPQ直至分娩。他们表示接受DHA - PPQ的主要动机是认为不应拒绝医护人员的指导。尽管一些HIVPW报告服用DHA - PPQ后出现眩晕、呕吐和不适，但他们表示愿意在未来怀孕时使用，相信这有助于获得健康的结果。孕妇和医护人员指出，支持接受DHA - PPQ的因素包括关于IPTp益处的信息、之前服用过DHA - PPQ的女性的推荐以及医护人员将DHA - PPQ送到家中。当DHA - PPQ（一种仅用于HIVPW的药物）在HIVPW家中发放时，认为在家中发放DHA - PPQ可能会影响确保艾滋病毒感染保密性的措施这一观念，并未被发现是接受DHA - PPQ的潜在障碍。
HIVPW对DHA - PPQ的接受程度似乎更多地受到对医护人员的信任影响，而非药物本身所带来的益处认知。利用这种信任来提高对DHA - PPQ益处的认识和理解，可能会进一步提高其接受程度。此外，专注于在现实环境中接受程度的进一步实施研究对于加深在临床试验环境之外对DHA - PPQ接受程度的理解并据此为政策决策提供信息至关重要。
