The landscape for HIV pre-exposure prophylaxis during pregnancy and breastfeeding in Malawi and Zambia: A qualitative study
The landscape for HIV pre-exposure prophylaxis during pregnancy and breastfeeding in Malawi and Zambia: A qualitative study
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DOI：
10.1371/journal.pone.0223487
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发表时间：
2019-10-04
期刊：
影响因子：
3.7
通讯作者：
Chi, Benjamin H.
中科院分区：
文献类型：
--
作者：
Zimba, Chifundo;Maman, Suzanne;Chi, Benjamin H.
在撒哈拉以南非洲，孕妇和哺乳期妇女的艾滋病毒感染率很高。口服暴露前预防（PrEP）可以有效地减少艾滋病毒感染的妇女在这些时期，但是，了解其可接受性和可行性在产前和产后人群仍然有限。为了解决这一差距，我们对马拉维和赞比亚的90名研究参与者进行了深入访谈：39名艾滋病毒阴性孕妇/哺乳期妇女，14名男性伴侣，19名医护人员和18名政策制定者。归纳和演绎的方法被用来确定与PrEP相关的主题。作为一种公共卫生干预措施，PrEP在患者和卫生保健工作者中并不知名;然而，当它被描述给参与者时，大多数人表达了积极的观点。对安全和遵守提出了关切，强调了社区外联的两个关键领域。将PrEP引入产前服务的可行性也是一个关切问题，特别是如果在已经紧张的卫生系统中引入。马拉维和赞比亚的决策者对准备工作的支持各不相同，反映了这两个国家正在进行的政策讨论。在怀孕和哺乳期间实施PrEP需要解决个人，设施和政策层面的障碍。在为产前和产后人群设计新的PrEP计划时，应考虑多层次的方法。
High HIV incidence rates have been observed among pregnant and breastfeeding women in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) can effectively reduce HIV acquisition in women during these periods; however, understanding of its acceptability and feasibility in antenatal and postpartum populations remains limited. To address this gap, we conducted in-depth interviews with 90 study participants in Malawi and Zambia: 39 HIV-negative pregnant/breastfeeding women, 14 male partners, 19 healthcare workers, and 18 policymakers. Inductive and deductive approaches were used to identify themes related to PrEP. As a public health intervention, PrEP was not well-known among patients and health-care workers; however, when it was described to participants, most expressed positive views. Concerns about safety and adherence were raised, highlighting two critical areas for community outreach. The feasibility of introducing PrEP into antenatal services was also a concern, especially if introduced within already strained health systems. Support for PrEP varied among policymakers in Malawi and Zambia, reflecting the ongoing policy discussions in their respective countries. Implementing PrEP during the pregnancy and breastfeeding periods will require addressing barriers at the individual, facility, and policy levels. Multilevel approaches should be considered in the design of new PrEP programs for antenatal and postpartum populations.