A Mixed-Methods Approach to Understanding Barriers to Postpartum Retention in Care Among Low-Income, HIV-Infected Women
A Mixed-Methods Approach to Understanding Barriers to Postpartum Retention in Care Among Low-Income, HIV-Infected Women
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DOI：
10.1089/apc.2014.0227
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发表时间：
2015-03-01
影响因子：
4.9
通讯作者：
Bell, Tanvir K.
中科院分区：
文献类型：
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作者：
Buchberg, Meredith K.;Fletcher, Faith E.;Bell, Tanvir K.
产后艾滋病毒护理的最佳保留是有益于母亲及其婴儿的健康和福祉的必要条件。然而，低收入妇女产后继续接受艾滋病毒护理的情况并不理想，特别是在美国南部。进行了一项混合方法研究，以确定与艾滋病毒感染妇女产后保留护理相关的因素。参与者（n=35）在怀孕期间在两个县诊所招募，并完成自我报告的人口统计和心理社会调查。22名妇女谁返回产后预约完成了半结构化的采访生活方式的因素和保留在照顾。在基线入组的参与者中，71.4%完成了产科医生（OB）的随访，而57.1%完成了初级保健医生（PCP）的随访。分娩时CD4计数高、基线时病毒载量低、抑郁水平低、人际社会支持高以及其他孩子较少与产后随访的完成显著相关。定性访谈中确定的保留障碍和促进因素包括时间上的责任竞争，直系亲属之外缺乏社会支持，交通工具有限，制度化耻辱的经历，对坚持的好处的了解，以及与医疗服务提供者的牢固关系。在该样本中，产科和PCP产后随访是次优的。研究结果强调了解决抑郁症状，社会支持，病毒抑制，时间竞争的责任，制度化的耻辱和交通问题的重要性，以减少阻碍妇女寻求产后艾滋病毒护理的障碍。
Optimal retention in HIV care postpartum is necessary to benefit the health and wellbeing of mothers and their infants. However, postpartum retention in HIV care among low-income women is suboptimal, particularly in the Southern United States. A mixed-methods study was conducted to identify factors associated with postpartum retention in care among HIV-infected women. Participants (n=35) were recruited during pregnancy at two county clinics and completed self-report demographic and psychosocial surveys. Twenty-two women who returned for a postpartum appointment completed a semi-structured interview about lifestyle factors and retention in care. Of the participants enrolled at baseline, 71.4% completed a follow-up with an obstetrician (OB), while 57.1% completed a follow-up with a primary care physician (PCP). High CD4 count at delivery, low viral load at baseline, low levels of depression, high interpersonal social support, and fewer other children were significantly associated with completion of postpartum follow-up. Barriers and facilitators to retention identified during qualitative interviews included competing responsibilities for time, lack of social support outside of immediate family members, limited transportation access, experiences of institutionalized stigma, knowledge about the benefits of adherence, and strong relationships with healthcare providers. OB and PCP follow-up postpartum was suboptimal in this sample. Findings underscore the importance of addressing depressive symptoms, social support, viral suppression, competing responsibilities for time, institutionalized stigma, and transportation issues in order to reduce the barriers that inhibit women from seeking postpartum HIV care.