The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub-Saharan Africa: state of the science and research priorities.
The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub-Saharan Africa: state of the science and research priorities.
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DOI：
10.1002/jia2.26026
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发表时间：
2022-10
影响因子：
6
通讯作者：
Psaros, Christina
中科院分区：
文献类型：
--
作者：
Stanton, Amelia M.;O'Cleirigh, Conall;Knight, Lucia;Davey, Dvora L. Joseph;Myer, Landon;Joska, John A.;Mayer, Kenneth H.;Bekker, Linda-Gail;Psaros, Christina
撒哈拉以南非洲的孕妇和产后妇女（PPW）与非孕妇相比，感染艾滋病毒的风险不成比例地高。如果持续使用，暴露前预防（PrEP）可以在这些关键时期防止HIV感染和传播给胎儿或婴儿。最近的研究表明，心理健康挑战（例如与亲密伴侣暴力相关的抑郁症和创伤性应激）与PrEP依从性和持久性下降之间存在关联，特别是在青少年，年轻女性和产后妇女中。然而，心理健康目前不是PrEP实施研究和PPW方案规划的主要重点。PPW的PrEP实施方案需要评估和解决持续使用PrEP的心理健康障碍，以确保常规护理的有效性和可持续性。我们强调了三个关键的研究重点，将支持PrEP的坚持和持久性：（1）包括心理健康筛查工具在PrEP实施研究与PPW，既要评估将这些工具纳入常规产前和产后护理的可行性，并确保有限的资源是针对妇女的症状可能会干扰最PrEP的使用;（2）确定影响这些时期持续使用PrEP的跨领域、跨诊断的心理机制，并且可以在资源有限的环境中进行切实的干预;以及（3）开发/调整和测试针对这些潜在机制的干预措施，利用现有干预措施中的战略，这些干预措施已成功减轻了人们使用抗逆转录病毒疗法的心理健康障碍感染了艾滋病毒对于PPW，PrEP的实施应通过对可能成为吸收，坚持和坚持（即随着时间的推移持续坚持）的障碍的独特心理困难的深刻理解来指导。我们强烈鼓励PPW的PrEP实施研究将经过验证的心理健康筛查工具和最终治疗纳入常规产前和产后护理，我们强调识别面临PrEP使用心理健康障碍的妇女的潜在公共卫生益处。
Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.
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