Ladner J, Leroy V, Msellati P, Nyiraziraje M, De Clercq A, Van de Perre P, Dabis F
Medical Information Unit, Centre Hospitalier de Kigali, Rwanda.
AIDS. 1996 Jan;10(1):69-75. doi: 10.1097/00002030-199601000-00010.
To identify factors associated with failure to return for HIV post-test counselling in pregnant women in Kigali (Rwanda).
In the context of a study on the impact of HIV infection on pregnancy, HIV-1-antibody testing was offered to all pregnant women attending the antenatal clinic of the Centre Hospitalier de Kigali from July 1992 to August 1993. Pre-test counselling was performed after verbal informed consent was obtained. Two weeks later, we formally enrolled all HIV-positive women and a corresponding number of HIV-negative women in a cohort. At this visit, post-test counselling was given to those wishing to be informed of their HIV serostatus. Level of knowledge about modes of HIV transmission and condom use were recorded. Four months after delivery, another interview was conducted to determine the proportion of women who used condoms regularly.
A total of 1233 pregnant women were screened. The HIV seroprevalence was 34.4% [95% confidence interval (CI), 31.7-37.1]; 271 (63.9%) out of 424 HIV-positive and 577 (71.3%) out of 809 HIV-negative women asked for their HIV serostatus (P = 0.008). In multivariate analysis, the only variable significantly associated with failure to return for post-test counselling was a positive HIV test result (odds ratio, 0.7; 95% CI, 0.5-0.9; P = 0.009), independently of obstetrical history and socioeconomic characteristics. Among the 848 women who had post-test counselling, 50.9% of the HIV-positive women and 94.6% of the HIV-negative women stated that they planned to inform their partner of their serostatus (P = 0.0001). More than 95% of the women interviewed knew about sexual and parenteral transmission of HIV, but half were unaware of mother-to-child transmission. More than 80% of the women had seen a condom before, but 14% only had used it at least once. Among women who were sexually active 4 months after delivery, 8.8% of the HIV-positive and 3.9% of the HIV-negative women reported using a condom (P = 0.04).
Innovative approaches for HIV testing and counselling programs are needed and the importance of psychosocial and cultural factors associated with HIV testing should be emphasized in African populations.
确定卢旺达基加利市孕妇艾滋病病毒检测后未返回接受咨询的相关因素。
在一项关于艾滋病病毒感染对妊娠影响的研究中，于1992年7月至1993年8月期间，为所有前往基加利中心医院产前诊所就诊的孕妇提供了艾滋病病毒1型抗体检测。在获得口头知情同意后进行检测前咨询。两周后，我们正式将所有艾滋病病毒阳性女性和相应数量的艾滋病病毒阴性女性纳入一个队列。在此次就诊时，为那些希望知晓自己艾滋病病毒血清学状态的女性提供检测后咨询。记录她们对艾滋病病毒传播方式和使用避孕套的知识水平。分娩后四个月，进行了另一次访谈，以确定定期使用避孕套的女性比例。
共筛查了1233名孕妇。艾滋病病毒血清阳性率为34.4%[95%置信区间（CI），31.7 - 37.1]；424名艾滋病病毒阳性女性中有271名（63.9%）、809名艾滋病病毒阴性女性中有577名（71.3%）询问了她们的艾滋病病毒血清学状态（P = 0.008）。在多变量分析中，与未返回接受检测后咨询显著相关的唯一变量是艾滋病病毒检测结果呈阳性（比值比，0.7；95%CI，0.5 - 0.9；P = 0.009），与产科病史和社会经济特征无关。在接受检测后咨询的848名女性中，50.9%的艾滋病病毒阳性女性和94.6%的艾滋病病毒阴性女性表示她们计划告知伴侣自己的血清学状态（P = 0.0001）。超过95%接受访谈的女性知晓艾滋病病毒的性传播和非肠道传播，但一半人不知道母婴传播。超过80%的女性以前见过避孕套，但只有14%的人至少使用过一次。在分娩后4个月有性行为的女性中，8.8%的艾滋病病毒阳性女性和3.9%的艾滋病病毒阴性女性报告使用了避孕套（P = 0.04）。
需要创新艾滋病病毒检测和咨询项目的方法，并且应在非洲人群中强调与艾滋病病毒检测相关的心理社会和文化因素的重要性。
