A qualitative exploration to understand barriers and facilitators to daily oral PrEP uptake and sustained adherence among HIV-negative women planning for or with pregnancy in rural Southwestern Uganda.
A qualitative exploration to understand barriers and facilitators to daily oral PrEP uptake and sustained adherence among HIV-negative women planning for or with pregnancy in rural Southwestern Uganda.
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DOI：
10.1002/jia2.25894
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发表时间：
2022-03
影响因子：
6
通讯作者：
Matthews LT
中科院分区：
文献类型：
--
作者：
Atukunda EC;Owembabazi M;Pratt MC;Psaros C;Muyindike W;Chitneni P;Bwana MB;Bangsberg D;Haberer JE;Marrazzo J;Matthews LT
抗逆转录病毒暴露前预防（PrEP）可能会降低妇女在性别权力失衡限制艾滋病毒检测，护理和艾滋病毒抑制的环境中的围产期和妊娠艾滋病毒发病率。我们进行了定性访谈，以了解影响围受孕和妊娠PrEP摄取和使用的因素，在乌干达西南部农村地区提供更安全的受孕咨询的一组妇女（试验注册：NCT 03832530）中，PrEP摄取率很高。在2018年3月至2019年1月期间，对37名女性进行了深入访谈，了解了降低围产期风险和PrEP依从性的概念框架，其中包括通过电子药丸帽测量的PrEP剂量依从性≥80%和<80%的女性，从未启动PrEP的女性以及7名男性伴侣。进行内容和二元分析，以确定个人和夫妇叙述中PrEP使用的紧急挑战和促进因素。女性的中位年龄为33岁（IQR 28，35），97%的人认为可能感染艾滋病毒，89%的人开始了PrEP。个人层面的障碍包括不愿意在健康时每天服用药丸，副作用和饮酒。妇女通过个人愿望克服了这些障碍，以控制其艾滋病毒血清状况，生产艾滋病毒阴性儿童并防止艾滋病毒在伙伴关系中传播。夫妻层面的障碍包括不披露、不信任和基于性别的暴力;促进者包括共同的目标和对艾滋病毒保护的认识，这通过自我控制的方法改善了伙伴关系中的沟通、性亲密和情感支持。社区层面的障碍包括与艾滋病毒、抗逆转录病毒药物/PrEP和血清差异相关的多层次耻辱;促进因素包括积极的同伴、家庭或医疗保健提供者的支持，因为妇女渴望安全地满足社会文化期望，以怀孕和保持血清差异关系。PrEP有效性的信心得到了PrEP和正在进行的艾滋病毒检测的积极同行经验的促进。多层次形式的艾滋病毒，血清差异和披露相关的耻辱，副作用，药丸负担，酒精使用，关系动态，社会，专业和伙伴关系支持适应和降低艾滋病毒风险影响艾滋病毒阴性妇女的PrEP摄取和坚持计划在乌干达西南部农村怀孕。对PrEP的信心，单独控制的艾滋病毒预防以及改善的伙伴关系沟通和亲密关系促进了PrEP的坚持。支持个人克服PrEP使用的特定背景障碍可能是改善吸收和长期使用的重要方法。
Antiretroviral pre‐exposure prophylaxis (PrEP) may reduce periconception and pregnancy HIV incidence among women in settings, where gender power imbalances limit HIV testing, engagement in care and HIV viral suppression. We conducted qualitative interviews to understand factors influencing periconception and pregnancy PrEP uptake and use in a cohort of women (Trial registration: NCT03832530) offered safer conception counselling in rural Southwestern Uganda, where PrEP uptake was high. Between March 2018 and January 2019, in‐depth interviews informed by conceptual frameworks for periconception risk reduction and PrEP adherence were conducted with 37 women including those with ≥80% and <80% adherence to PrEP doses measured by electronic pill cap, those who never initiated PrEP, and seven of their male partners. Content and dyadic analyses were conducted to identify emergent challenges and facilitators of PrEP use within individual and couple narratives. The median age for women was 33 years (IQR 28, 35), 97% felt likely to acquire HIV and 89% initiated PrEP. Individual‐level barriers included unwillingness to take daily pills while healthy, side effects and alcohol use. Women overcame these barriers through personal desires to have control over their HIV serostatus, produce HIV‐negative children and prevent HIV transmission within partnerships. Couple‐level barriers included nondisclosure, mistrust and gender‐based violence; facilitators included shared goals and perceived HIV protection, which improved communication, sexual intimacy and emotional support within partnerships through a self‐controlled method. Community‐level barriers included multi‐level stigma related to HIV, ARVs/PrEP and serodifference; facilitators included active peer, family or healthcare provider support as women aspired to safely meet socio‐cultural expectations to conceive and preserve serodifferent relationships. Confidence in PrEP effectiveness was promoted by positive peer experiences with PrEP and ongoing HIV testing. Multi‐level forms of HIV‐, serodifference‐ and disclosure‐related stigma, side effects, pill burden, alcohol use, relationship dynamics, social, professional and partnership support towards adaptation and HIV risk reduction influence PrEP uptake and adherence among HIV‐negative women with plans for pregnancy in rural Southwestern Uganda. Confidence in PrEP, individually controlled HIV prevention and improved partnership communication and intimacy promoted PrEP adherence. Supporting individuals to overcome context‐specific barriers to PrEP use may be an important approach to improving uptake and prolonged use.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
影响因子：
3.8
作者：
Heys, Jennifer;Kipp, Walter;Rubaale, Tom
通讯作者：
Rubaale, Tom
影响因子：
4.4
作者：
Atukunda EC;Musiimenta A;Musinguzi N;Wyatt MA;Ashaba J;Ware NC;Haberer JE
通讯作者：
Haberer JE
与乌干达西南部艾滋病毒的产后妇女怀孕意图有关的因素。
影响因子：
4.4
作者：
Atukunda EC;Mugyenyi GR;Atuhumuza EB;Kaida A;Boatin A;Agaba AG;Matthews LT
通讯作者：
Matthews LT
DOI：
10.1016/s2352-3018(20)30307-6
发表时间：
2021-03
期刊：
The lancet. HIV
影响因子：
--
作者：
Haberer JE;Bukusi EA;Mugo NR;Pyra M;Kiptinness C;Oware K;Garrison LE;Thomas KK;Musinguzi N;Morrison S;Anderson PL;Ngure K;Baeten JM;MPYA Study Team
通讯作者：
MPYA Study Team