Frequency and factors associated with adherence to and completion of combination antiretroviral therapy for prevention of mother to child transmission in western Kenya
Frequency and factors associated with adherence to and completion of combination antiretroviral therapy for prevention of mother to child transmission in western Kenya
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DOI：
10.7448/ias.16.1.17994
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发表时间：
2013-01-02
影响因子：
6
通讯作者：
Wools-Kaloustian, Kara
中科院分区：
文献类型：
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作者：
Ayuo, Paul;Musick, Beverly;Wools-Kaloustian, Kara
本分析的目的是确定从联合抗逆转录病毒治疗（CART）开始到分娩的预防母婴传播（PMTCT）连续体中的中断点。方法：为了实现这一目标，对2006年1月至2009年2月在肯尼亚西部提供医疗保健学术模式（AMPATH）范围内为预防母婴传播而启动CART的所有未接受抗逆转录病毒治疗的成年孕妇的电子病历进行了审查。研究的结果是临床医生主动改变或停止治疗方案，脱离治疗方案（任何，早期，晚期）和自我报告的药物依从性。脱离接触被分类为早期脱离接触（就诊间隔超过30天，但在分娩前返回护理）或晚期脱离接触（分娩前30天内未就诊）。使用双变量（连续变量的Kruskal-Wallis检验和分类变量的卡方检验）和多变量逻辑回归分析评估协变量与相关结果之间的关联。结果：2006年1月至2009年2月，共有4284名未接受抗逆转录病毒治疗的孕妇接受了CART治疗。大多数妇女（89%）报告在每次就诊时都服用了所有药物。报告有18例（0.4%）死亡。临床医生有10名患者（0.7%）停止了CART治疗，1367名（31.9%）女性脱离了护理。在这些离职者中，404人（29.6%）早离职，963人（70.4%）晚离职。在多变量模型中，随着年龄的增加（比值比[OR] 0.982；置信区间[CI] 0.966 ~ 0.998）和CART开始时胎龄的增加（OR 0.925; CI 0.909 ~ 0.941），脱离的几率降低。在地区医院接受治疗（OR 0.794；可信区间0.644-0.980）或结核病药物治疗（OR 0.457；可信区间0.202-0.935）的妇女脱离参与的可能性较小。已婚女性脱离工作的几率更高（OR 1.277; CI 1.034-1.584）。在CART开始时，早期脱离的几率随着年龄的增加而降低（OR 0.902; CI 0.881-0.924）。在CART开始时，随着年龄的增加，后期脱离的几率降低（OR 0.936; CI 0.917-0.956）。当CD4细胞计数在CART开始时（OR为1.001；CI为1.000-1001）和已婚妇女（OR为1.297；CI为1.000-1.695）增加时，结论：在一个积极推广部门的抗逆转录病毒治疗方案中，大多数（67.4%）妇女仍然参与并接受不间断的产前CART。
Introduction: The objective of this analysis was to identify points of disruption within the prevention of mother-to-child transmission (PMTCT) continuum from combination antiretroviral therapy (CART) initiation until delivery.Methods: To address this objective, the electronic medical records of all antiretroviral-naive adult pregnant women who were initiating CART for PMTCT between January 2006 and February 2009 within the Academic Model Providing Access To Healthcare (AMPATH), western Kenya, were reviewed. Outcomes of interest were clinician-initiated change or stop in regimen, disengagement from programme (any, early, late) and self-reported medication adherence. Disengagement was categorized as early disengagement (any interval of greater than 30 days between visits but returning to care prior to delivery) or late disengagement (no visit within 30 days prior to the date of delivery). The association between covariates and the outcomes of interest were assessed using bivariate (Kruskal-Wallis test for continuous variables and the Chi-square test for categorical variables) and multivariate logistic regression analysis.Results: A total of 4284 antiretroviral-naive pregnant women initiated CART between January 2006 and February 2009. The majority of women (89%) reported taking all of their medication at every visit. There were 18 (0.4%) deaths reported. Clinicians discontinued CART in 10 patients (0.7%) while 1367 (31.9%) women disengaged from care. Of those disengaging, 404 (29.6%) disengaged early and 963 (70.4%) late. In the multivariate model, the odds of disengagement decreased with increasing age (odds ratio [OR] 0.982; confidence interval [CI] 0.966-0.998) and increasing gestational age at CART initiation (OR 0.925; CI 0.909-0.941). Women receiving care at a district hospital (OR 0.794; CI 0.644-0.980) or tuberculosis medication (OR 0.457; CI 0.202-0.935) were less likely to disengage. The odds of disengagement were higher in married women (OR 1.277; CI 1.034-1.584). The odds of early disengagement decreased with increasing age at CART initiation (OR 0.902; CI 0.881-0.924). The odds of late disengagement decreased with increasing age at CART initiation (OR 0.936; CI 0.917-0.956). While they increased with higher CD4 counts at CART-initiation (OR 1.001; CI 1.000-1001) and in married women (OR 1.297; CI 1.000-1.695)Conclusions: In a PMTCT programme embedded in an antiretroviral treatment programme with an active outreach department, the majority (67.4%) of women remained engaged and received uninterrupted prenatal CART.