Lessons learned from the PMTCT program in Swaziland: challenges with accepting lifelong ART for pregnant and lactating women - a qualitative study
Lessons learned from the PMTCT program in Swaziland: challenges with accepting lifelong ART for pregnant and lactating women - a qualitative study
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DOI：
10.1186/s12889-016-3767-5
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发表时间：
2016-10-24
影响因子：
4.5
通讯作者：
Tylleskar, Thorkild
中科院分区：
文献类型：
--
作者：
Katirayi, Leila;Chouraya, Caspian;Tylleskar, Thorkild
背景：斯威士兰是撒哈拉以南非洲地区艾滋病病毒感染率最高的国家之一，26%的成年人口感染艾滋病病毒。孕妇的患病率最高，为41.1%。根据斯威士兰的预防母婴传播准则，大约50%的孕妇符合CD 4标准（< 350个细胞/毫升）的抗逆转录病毒疗法。研究表明，大多数母婴传播和产后死亡发生在有资格接受抗逆转录病毒治疗的妇女中，因此，确保有资格接受抗逆转录病毒治疗的妇女开始接受抗逆转录病毒治疗，对于防止母婴传播和母婴存活至关重要。这项研究提供了深入了解终身抗逆转录病毒治疗开始在斯威士兰的孕妇在选项A的挑战。我们认为，这些挑战和经验教训，从启动妇女终身抗逆转录病毒治疗方案A下是相关的，重要的是要考虑在实施方案B+。方法：HIV阳性，治疗合格，产后妇女和护士招募孕产妇和儿童保健（MCH）单位使用方便和有目的的抽样。与会者来自城市和农村地区。进行了焦点小组讨论（FGD）和使用简短回答问卷的结构化访谈，以了解启动终身ART时遇到的挑战。（5-11名参与者）进行了四次与护士的FGD，两次与开始ART的妇女的FGD，以及一次与未开始ART的妇女的FGD。50名开始ART的女性和33名未开始ART的女性。与妇女的数据收集是用当地语言SiSwati进行的，与护士的数据收集是用英语进行的。对FGD进行录音，同时转录并翻译成英文。采用专题分析法进行了分析。转录本由两名研究人员在定性软件程序MAXqda v.10中编码。专题调查结果使用逐字引述加以说明，逐字引述是根据代表某一具体专题而选择的。简短的回答访谈问卷包括具体的问题，在妇女的经验启动ART的不同步骤，因此，每个问题的答案进行了分析separately.Results：研究结果突出妇女的感觉不堪重负的一生承诺的ART，感觉“健康”时，要求启动ART，偏好短期的预防和恐惧的副作用（身体变化）。此外，护士的偏好，以个人为基础，确定咨询预约的数量一名妇女需要在启动ART，更多的信息，艾滋病毒和ART需要在社区一级，并需要教育男子有关艾滋病毒和ART。了解妇女的关切将有助于制定有效的咨询信息，设计适当的咨询结构，了解在启动抗逆转录病毒疗法的过程中需要额外支持的地方，并知道社区一级信息的目标是谁。
Background: Swaziland has one of the highest HIV prevalence rates in sub-Saharan Africa, 26 % of the adult population is infected with HIV. The prevalence is highest among pregnant women, at 41.1 %. According to Swaziland's prevention of mother-to-child transmission (PMTCT) guidelines, approximately 50 % of pregnant women are eligible for antiretroviral therapy (ART) by CD4 criteria (< 350 cells/ml). Studies have shown that most mother-to-child transmission and postnatal deaths occur among women who are eligible for ART. Therefore, ensuring that ART eligible women are initiated on ART is critical for PMTCT and for mother and baby survival. This study provides insight into the challenges of lifelong ART initiation among pregnant women under Option A in Swaziland. We believe that these challenges and lessons learned from initiating women on lifelong ART under Option A are relevant and important to consider during implementation of Option B+.Methods: HIV-positive, treatment-eligible, postpartum women and nurses were recruited within maternal and child health (MCH) units using convenience and purposive sampling. Participants came from both urban and rural areas. Focus group discussions (FGDs) and structured interviews using a short answer questionnaire were conducted to gain an understanding of the challenges experienced when initiating lifelong ART. Seven FGDs (of 5-11 participants) were conducted, four FGDs with nurses, two FGDs with women who initiated ART, and one FGD with women who did not initiate ART. A total of 83 interviews were conducted; 50 with women who initiated ART and 33 with women who did not initiate. Data collection with the women was conducted in the local language of SiSwati and data collection with the nurses was done in English. FGDs were audio-recorded and simultaneously transcribed and translated into English. Analysis was conducted using thematic analysis. Transcripts were coded by two researchers in the qualitative software program MAXqda v.10. Thematic findings were illustrated using verbatim quotes which were selected on the basis of being representative of a specific theme. The short-answer interview questionnaire included specific questions about the different steps in the woman's experience initiating ART; therefore the responses for each question were analyzed separately.Results: Findings from the study highlight women feeling overwhelmed by the lifetime commitment of ART, feeling "healthy" when asked to initiate ART, preference for short-course prophylaxis and fear of side effects (body changes). Also, the preference for nurses to determine on an individual basis the number of counseling appointments a woman needs before initiating ART, more information about HIV and ART needed at the community level, and the need to educate men about HIV and ART.Conclusion: Women face a myriad of challenges initiating lifelong ART. Understanding women's concerns will aid in developing effective counseling messages, designing appropriate counseling structures, understanding where additional support is needed in the process of initiating ART, and knowing who to target for community level messages.