Implementation and Operational Research: Barriers and Facilitators to Combined ART Initiation in Pregnant Women With HIV: Lessons Learnt From a PMTCT B+ Pilot Program in Swaziland.
Implementation and Operational Research: Barriers and Facilitators to Combined ART Initiation in Pregnant Women With HIV: Lessons Learnt From a PMTCT B+ Pilot Program in Swaziland.
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DOI：
10.1097/qai.0000000000000537
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发表时间：
2015-05-01
期刊：
影响因子：
--
通讯作者：
Teck R
中科院分区：
文献类型：
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作者：
Parker LA;Jobanputra K;Okello V;Nhlangamandla M;Mazibuko S;Kourline T;Kerschberger B;Pavlopoulos E;Teck R
补充数字内容在文本中可用。2013年1月，斯威士兰在Shiselweni农村启动了一项预防艾滋病毒母婴传播B+实施研究。我们的目的是确定患者和卫生服务的联合抗逆转录病毒治疗（ART）的启动，以帮助指导国家实施的PMTCT B+的决定因素。这项前瞻性队列研究使用了来自PMTCT B+试验区和相邻健康区（PMTCT A为标准治疗）的登记和患者档案的常规数据。纳入了2013年1月28日至2013年12月31日期间首次产前护理访视时未接受联合抗逆转录病毒治疗的所有艾滋病毒阳性妇女。包括399名来自预防母婴传播B+区的妇女和183名来自预防母婴传播A区的妇女。妊娠32周前未开始抗逆转录病毒干预的妇女在预防母婴传播A区的总体比例较低（13%对25%，P = 0.003），但在预防母婴传播B+区，CD 4 <350的妇女开始联合抗逆转录病毒治疗的比例较高（86%对74%，P = 0.032）。在预防母婴传播B+试点项目中，不同卫生机构的启动率差异很大;而在患者层面，CD 4 350的妇女启动抗逆转录病毒治疗的比例明显较高<350 compared with CD4 >（80%比59%，P < 0.001）。在CD 4 <350的妇女中，那些被记录为新诊断的妇女更有可能开始联合抗逆转录病毒治疗。虽然较低的教育水平和职业障碍似乎阻碍了CD 4>350的妇女开始联合抗逆转录病毒治疗，但由于社会人口学数据缺失的比例很高，因此无法就此得出任何明确的结论。这项研究不仅证明了启动孕妇接受抗逆转录病毒治疗的挑战，而且还确定了预防母婴传播B+提供的机会，以改善CD 4计数较低的妇女的治疗启动。
Supplemental Digital Content is Available in the Text. In January 2013, Swaziland launched a prevention of mother-to-child transmission of HIV (PMTCT) B+ implementation study in rural Shiselweni. We aimed to identify patient and health service determinants of combined antiretroviral therapy (ART) initiation to help guide national implementation of PMTCT B+. This prospective cohort study uses routine data from registers and patient files in the PMTCT B+ pilot zone and a neighboring health zone where PMTCT A was the standard of care. All HIV-positive women not on combined ART at the first antenatal care visit between January 28, 2013 and December 31, 2013 were included. 399 women from the PMTCT B+ zone and 183 from the PMTCT A zone are included. The overall proportion of women who had not started an antiretroviral intervention before 32 weeks' gestation was lower in the PMTCT A zone (13% vs 25%, P = 0.003), yet a higher proportion women with CD4 <350 initiated combined ART in the PMTCT B+ zone (86% vs 74%, P = 0.032). Within the PMTCT B+ pilot, initiation rates were highly variable between health facilities; while at patient level, ART initiation was significantly higher among women with CD4 <350 compared with CD4 >350 (80% vs 59%, P < 0.001). Among women with CD4 <350, those recorded as newly diagnosed were more likely to initiate combined ART. Although lower educational level and occupational barriers seemed to hinder combined ART initiation among women with CD4 >350, high proportions of missing socio-demographic data made it impossible to make any firm conclusions to this respect. This study not only demonstrates challenges in initiating pregnant women on ART, but also identifies opportunities offered by PMTCT B+ for improving treatment initiation among women with lower CD4 counts.