Early pre-exposure prophylaxis (PrEP) initiation and continuation among pregnant and postpartum women in antenatal care in Cape Town, South Africa.
Early pre-exposure prophylaxis (PrEP) initiation and continuation among pregnant and postpartum women in antenatal care in Cape Town, South Africa.
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DOI：
10.1002/jia2.25866
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发表时间：
2022-03
影响因子：
6
通讯作者：
Myer L
中科院分区：
文献类型：
--
作者：
Joseph Davey DL;Mvududu R;Mashele N;Lesosky M;Khadka N;Bekker LG;Gorbach P;Coates TJ;Myer L
暴露前预防（PrEP）是一种安全有效的预防策略，可降低妇女在怀孕和产后感染艾滋病毒的风险。有效的PrEP保护需要每天坚持使用PrEP，但对母体PrEP的持续使用和影响PrEP使用的因素知之甚少。孕期和产后PrEP （PrEP - PP）研究招募了首次产前护理（ANC）时同意怀孕的HIV阴性妇女，并随访至产后12个月。≥16岁的符合条件且同意的妇女和女孩接受了艾滋病毒预防咨询，并提供了PrEP。采访者在每次访问时收集参与者的社会人口统计学和行为数据。我们分析了开始PrEP的妇女比例和3个月后继续PrEP的比例，并通过估计经先验混杂因素调整的患病率来分析相关因素。在2019年8月至2021年10月期间，我们招募了1201名孕妇（中位妊娠21周，年龄26岁）；84%的妇女在第一次ANC就诊时就开始了PrEP (n = 1014)；55%的人已婚或同居。总体而言，66%接受PrEP治疗的女性在1个月后再次接受处方；58%在3个月后复发（n = 493 / 844）。几乎一半接受PrEP治疗的妇女在1个月时报告了副作用，主要是恶心/呕吐。与产后妇女相比，妊娠早期和中期接受PrEP的妇女报告副作用的几率更高（aOR 2.61; 95% CI 1.17-5.84）。报告副作用的妇女继续服用PrEP的人数少于未报告副作用的妇女（aPR = 0.87; 95% CI 0.77-0.97）。妊娠史≥1次的妇女（aPR = 0.76; 95% CI 0.57-1.01）或产后妇女（aPR 0.85; 95% CI 0.75-0.97）与初产妇或孕妇相比，继续使用PrEP的可能性较小。报告有HIV阳性伴侣（aPR = 1.45; 95% CI = 1.13-1.85）或HIV高危认知（aPR = 1.20, 95% CI = 1.01-1.41）的女性比那些HIV阴性伴侣或低风险认知的女性更有可能继续使用PrEP。与其他女性研究相比，在这种情况下，PrEP的开始和早期继续率很高。产后和经历副作用与较低的PrEP延续相关，这为早期短暂副作用提供了咨询机会。需要对服用PrEP的产后妇女采取干预措施。
Pre‐exposure prophylaxis (PrEP) is a safe and effective prevention strategy to reduce women's risk of HIV in pregnancy and postpartum. Effective PrEP protection requires daily PrEP adherence, but little is known about maternal PrEP continuation and factors that influence PrEP use. The PrEP in pregnancy and postpartum (PrEP‐PP) study enrolled consenting pregnant, HIV‐negative women at first antenatal care (ANC) visit with follow‐up through 12 months postpartum. Eligible and consenting women and girls ≥16 years received HIV prevention counselling and were offered PrEP. Interviewers collected socio‐demographic and behavioural data from participants at each visit. We analysed the proportion of women who initiated PrEP and the proportion who continued PrEP after 3 months with associated correlates by estimating the prevalence ratio adjusting for a priori confounders. Between August 2019 and October 2021, we enrolled 1201 pregnant women (median gestation 21 weeks; age 26 years); 84% of women initiated PrEP at their first ANC visit (n = 1014); 55% were married or cohabiting. Overall, 66% of women on PrEP returned for a repeat prescription at 1 month; 58% returned at 3 months (n = 493 of 844). Almost one‐half of women on PrEP reported a side effect at 1 month, mostly nausea/vomiting. Women on PrEP in the first and second trimesters had higher odds of reporting side effects (aOR 2.61; 95% CI 1.17–5.84) versus postpartum women. Women who reported side effects continued with PrEP less than those who did not report side effects (aPR = 0.87; 95% CI 0.77–0.97). Women with ≥1 previous pregnancy (aPR = 0.76; 95% CI 0.57–1.01) or were postpartum (aPR 0.85; 95% CI 0.75–0.97) were less likely to continue PrEP compared to women who were primigravid or pregnant. Women who reported having an HIV+ partner (aPR = 1.45; 95% CI 1.13–1.85) or high HIV risk perception (aPR = 1.20, 95% CI = 1.01–1.41) were more likely to continue on PrEP than those who had HIV‐negative partners or low risk perception. PrEP initiation and early continuation were high in this setting, compared to other studies in women. Being postpartum and experiencing side effects were associated with lower PrEP continuation, presenting opportunities for counselling on early transient side effects. Interventions for postpartum women on PrEP are needed.
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影响因子：
6
作者：
Velloza, Jennifer;Khoza, Nomhle;Delany-Moretlwe, Sinead
通讯作者：
Delany-Moretlwe, Sinead
影响因子：
6
作者：
Celum, Connie L.;Delany-Moretlwe, Sinead;Bekker, Linda-Gail
通讯作者：
Bekker, Linda-Gail
影响因子：
3.8
作者：
Davey, Dvora L. Joseph;Bekker, Linda-Gail;Johnson, Leigh F.
通讯作者：
Johnson, Leigh F.
影响因子：
4.1
作者：
Thomson KA;Baeten JM;Mugo NR;Bekker LG;Celum CL;Heffron R
通讯作者：
Heffron R
DOI：
10.1097/qad.0000000000001604
发表时间：
2017-10-23
期刊：
AIDS (London, England)
影响因子：
--
作者：
Joseph Davey DL;Bekker LG;Gorbach PM;Coates TJ;Myer L
通讯作者：
Myer L