Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B plus ) in selected health facilities in Zimbabwe: a qualitative study
Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B plus ) in selected health facilities in Zimbabwe: a qualitative study
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DOI：
10.1186/s12889-017-4611-2
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发表时间：
2017-07-25
影响因子：
4.5
通讯作者：
Woelk, Godfrey
中科院分区：
文献类型：
--
作者：
Chadambuka, Addmore;Katirayi, Leila;Woelk, Godfrey
背景：津巴布韦卫生和儿童保育部 (MOHCC) 通过了 2013 年世界卫生组织 (WHO) 预防艾滋病毒母婴传播 (PMTCT) 指南，建议艾滋病毒阳性孕妇和哺乳期妇女 (PPBW) 开始终身抗逆转录病毒治疗 (ART)，无论临床阶段如何（选项 B+）。 Option B+于2013年11月在津巴布韦正式推出；方法：在哈拉雷（城市）和兹维姆巴（农村）的选定地点进行了一项定性研究，以探讨选项 B+ 的可接受性； ART 依从性和服务采用的障碍和促进因素。与 PPBW、医疗保健提供者和社区成员进行了深度访谈 (IDIs)、焦点小组讨论 (FGD) 和关键知情人访谈 (KII)。所有采访均经过录音、转录和翻译；数据在 MaxQDA v10 中进行编码和分析。结果：进行了 43 次 IDI、22 次 FGD 和 5 次 KII。大多数女性接受终身抗逆转录病毒治疗。然而，人们担心承诺终生服用药物，因为他们害怕违约，尤其是在停止母乳喂养之后。剂量方面存在混乱；害怕副作用、没有足够的食物来服用药物，以及缺乏在咨询中提问的机会。参与者报告需要加强社区对选项 B+ 的认识。促进者包括接受简化的药物治疗方案；能够像 HIV 阴性女性一样继续母乳喂养 6 个月以上；以及合作伙伴、社区和卫生工作者的支持。障碍包括医疗机构的距离、未披露 HIV 状况、男性伴侣支持不佳以及认识有过 ART 负面经历的人。结论：这项研究发现，选项 B+ 被 PPBW 普遍接受，作为增强健康和保护婴儿的一种手段。与之前的文献一致，这项研究证明了男性伴侣和社区支持对于令人满意地坚持 ART 和增强咨询技术的重要性。加强社区宣传和男性知识对于鼓励妇女披露其艾滋病毒感染状况并确保成功坚持接受抗逆转录病毒疗法至关重要。针对女性伴侣并让其参与其中仍将是女性接受和坚持选项 B+ 下的 ART 的关键决定因素。
Background: Zimbabwe's Ministry of Health and Child Care (MOHCC) adopted 2013 World Health Organization (WHO) prevention of mother-to-child HIV transmission (PMTCT) guidelines recommending initiation of HIV-positive pregnant and breastfeeding women (PPBW) on lifelong antiretroviral treatment (ART) irrespective of clinical stage (Option B+). Option B+ was officially launched in Zimbabwe in November 2013; however the acceptability of life-long ART and its potential uptake among women was not known.Methods: A qualitative study was conducted at selected sites in Harare (urban) and Zvimba (rural) to explore Option B+ acceptability; barriers, and facilitators to ART adherence and service uptake. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with PPBW, healthcare providers, and community members. All interviews were audio-recorded, transcribed, and translated; data were coded and analyzed in MaxQDA v10.Results: Forty-three IDIs, 22 FGDs, and five KIIs were conducted. The majority of women accepted lifelong ART. There was however, a fear of commitment to taking lifelong medication because they were afraid of defaulting, especially after cessation of breastfeeding. There was confusion around dosage; and fear of side effects, not having enough food to take drugs, and the lack of opportunities to ask questions in counseling. Participants reported the need for strengthening community sensitization for Option B+. Facilitators included receiving a simplified pill regimen; ability to continue breastfeeding beyond 6 months like HIV-negative women; and partner, community and health worker support. Barriers included distance of health facility, non-disclosure of HIV status, poor male partner support and knowing someone who had negative experience on ART.Conclusions: This study found that Option B+ is generally accepted among PPBW as a means to strengthen their health and protect their babies. Consistent with previous literature, this study demonstrated the importance of male partner and community support in satisfactory adherence to ART and enhancing counseling techniques. Strengthening community sensitization and male knowledge is critical to encourage women to disclose their HIV status and ensure successful adherence to ART. Targeting and engaging partners of women will remain key determinants to women's acceptance and adherence on ART under Option B+.