Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review
Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review
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DOI：
10.1111/j.1365-3156.2012.02958.x
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发表时间：
2012-05-01
影响因子：
3.3
通讯作者：
Ross, David A.
中科院分区：
文献类型：
--
作者：
Ferguson, Laura;Grant, Alison D.;Ross, David A.
在低收入或中等收入国家，通过综合目前关于这一主题的文献，量化在妊娠相关服务中检测出艾滋病毒阳性的妇女与获得长期艾滋病毒护理和治疗服务之间的损耗，并探讨客户退出的潜在原因。方法系统检索Medline、EMBASE、Global Health和International Bibliography收录的2000-2010年社会科学文献。只有符合预先定义的质量标准的研究才被纳入。结果在2543篇检索文献中，20篇符合纳入标准。16个国家（80%）的数据来自撒哈拉以南非洲。在妊娠相关服务中检测艾滋病毒阳性和获得长期艾滋病毒相关服务之间的途径是复杂的，损耗通常很高。38-88%的已知符合条件的妇女未能开始高效抗逆转录病毒治疗（HAART）。提供“以家庭为中心的护理”，并将CD4检测和HAART提供纳入预防母婴艾滋病毒传播服务，似乎有望增加妇女对艾滋病毒相关服务的接受。需要解决的个人层面因素包括财政限制和对耻辱的恐惧。从在妊娠相关服务中检测艾滋病毒呈阳性到为自己获得艾滋病毒相关服务之间的许多步骤，很少有妇女进行协商。最近遏制患者辍学的努力，如MTCT-Plus倡议，带来了希望。解决保健设施内部以及妇女个人、其家庭和社会各级的障碍和有利因素，对于改善服务的利用至关重要。
Objectives To quantify attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services in low- or middle-income countries and to explore the reasons underlying client drop-out by synthesising current literature on this topic. methods A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000-2010. Only studies meeting pre-defined quality criteria were included. results Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from subSaharan Africa. The pathway between testing HIV-positive in pregnancy-related services and accessing long-term HIV-related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38-88% of known-eligible women. Providing ` family-focused care', and integrating CD4 testing and HAART provision into prevention of mother-tochild HIV transmission services appear promising for increasing women's uptake of HIV-related services. Individual-level factors that need to be addressed include financial constraints and fear of stigma. conclusions Too few women negotiate the many steps between testing HIV-positive in pregnancyrelated services and accessing HIV-related services for themselves. Recent efforts to stem patient dropout, such as the MTCT-Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services.