Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis.
Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis.
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DOI：
10.1097/qad.0b013e328359590f
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发表时间：
2012-10-23
期刊：
影响因子：
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通讯作者：
Mofenson LM
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文献类型：
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作者：
Nachega JB;Uthman OA;Anderson J;Peltzer K;Wampold S;Cotton MF;Mills EJ;Ho YS;Stringer JS;McIntyre JA;Mofenson LM
估计高、中、低收入国家孕期和产后的抗逆转录病毒治疗坚持率。检索MEDLINE、EMBASE、SCI Web of Science、NLM Gateway和Google scholar数据库中的系统综述和荟萃分析。我们纳入了所有报告依从率作为HIV感染孕妇主要或次要结局的研究。两名独立的评审员提取了关于依从性和研究特征的数据。使用随机效应模型汇总依从率;评估敏感性、异质性和发表偏倚。在72篇符合条件的文章中，纳入了51项研究，涉及20，153名HIV感染孕妇。大多数研究来自美国（n=14，27%），其次是肯尼亚（n=6，12%）、南非（n=5，10%）和赞比亚（n=5，10%）。定义对ART的良好依从性的阈值在不同研究中有所不同（> 80%，> 90%，> 95%，100%）。对所有研究的汇总分析表明，汇总估计73.5%（95%置信区间[CI] 69.3 - 77.5%，I2= 97.7%）的孕妇有充分的（>=80%）ART依从性。产前（75.7%，95% CI 71.5 - 79.7%）具有足够依从性水平的妇女的汇总比例高于产后（53.0%，95% CI 32.8%-72.7%）（p= 0.005）。选定的不依从障碍包括身体，经济和情感压力，抑郁症（特别是分娩后），酒精或药物使用，以及ART给药频率或药丸负担。我们的研究结果表明，只有73.5%的孕妇达到了最佳的ART依从性。达到足够的抗逆转录病毒疗法坚持水平是一个挑战，在怀孕期间，但特别是在产后期间。迫切需要在全球范围内开展进一步研究，调查具体的障碍并采取干预措施来解决这些障碍。
To estimate ART adherence rates during pregnancy and postpartum in high-, middle- and low-income countries. Systematic review and meta-analysis MEDLINE, EMBASE, SCI Web of Science, NLM Gateway and Google scholar databases were searched. We included all studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed. Of 72 eligible articles, 51studies involving 20,153 HIV-infected pregnant women were included. Most studies were from United States (n=14, 27%) followed by Kenya (n=6, 12%), South Africa (n=5, 10%), and Zambia (n=5, 10%). The threshold defining good adherence to ART varied across studies (>80%, >90%, >95%, 100%). A pooled analysis of all studies indicated a pooled estimate of 73.5% (95% confidence interval [CI] 69·3–77·5%, I2=97·7%) of pregnant women had adequate (>=80%) ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum (75·7%, 95% CI 71·5–79·7%) than during postpartum (53·0%, 95% 32.8% to 72·7%) (p=0·005). Selected reported barriers for non-adherence included physical, economic and emotional stresses, depression (especially post-delivery), alcohol or drug use, and ART dosing frequency or pill burden. Our findings indicate that only 73·5% of pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and interventions to address them are urgently needed globally.