A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women.
A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women.
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DOI：
10.1371/journal.pone.0108150
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Fogg K
中科院分区：
文献类型：
--
作者：
Colvin CJ;Konopka S;Chalker JC;Jonas E;Albertini J;Amzel A;Fogg K
尽管全球在降低孕产妇死亡率的斗争中取得了进展，但与艾滋病毒有关的孕产妇死亡率仍然居高不下，特别是在非洲大部分地区。终身抗逆转录病毒治疗（ART）似乎是预防这些死亡的最有效的方法，但三个关键结局——ART开始治疗、持续治疗和长期ART坚持——的比率仍然很低。这项系统评价综合了影响感染艾滋病毒的孕妇和产后妇女这些结局的卫生系统因素的证据。检索了涉及感兴趣人群（感染艾滋病毒的孕妇和产后妇女）、感兴趣的干预（ART）和感兴趣的结果（开始、坚持和保留）的研究。自2008年1月以来以英文发表的定量和定性研究包括在内。采用四阶段叙事综合设计分析研究结果。纳入的42项研究的回顾结果根据五个主题进行了分类：1)护理模式，2)服务提供，3)资源限制和治理挑战，4)患者卫生系统参与，5)孕产妇抗逆转录病毒治疗干预。母体抗逆转录病毒治疗的低优先级和母体抗逆转录病毒治疗级联的持续退出是主要发现。提供服务的障碍包括卫生系统行为体之间沟通和协调不良、临床实践不良以及提供者培训方面的差距。少数评估孕产妇抗逆转录病毒治疗干预措施的研究显示了多管齐下、多层次干预措施的重要性。对感染艾滋病毒的孕妇和产后妇女的经历、需要和脆弱性缺乏重视。支持这些妇女成功地完成孕产妇抗逆转录病毒药物梯级治疗需要在整个步骤中精心设计和有针对性的干预措施。在这项工作中，仔细设计综合服务提供模式至关重要。还确定了关键的知识差距和研究重点，包括依从率的定义和指标，以及沿孕产妇抗逆转录病毒治疗级联的累计辍学措施的重要性。
Despite global progress in the fight to reduce maternal mortality, HIV-related maternal deaths remain persistently high, particularly in much of Africa. Lifelong antiretroviral therapy (ART) appears to be the most effective way to prevent these deaths, but the rates of three key outcomes—ART initiation, retention in care, and long-term ART adherence—remain low. This systematic review synthesized evidence on health systems factors affecting these outcomes in pregnant and postpartum women living with HIV. Searches were conducted for studies addressing the population of interest (HIV-infected pregnant and postpartum women), the intervention of interest (ART), and the outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. A four-stage narrative synthesis design was used to analyze findings. Review findings from 42 included studies were categorized according to five themes: 1) models of care, 2) service delivery, 3) resource constraints and governance challenges, 4) patient-health system engagement, and 5) maternal ART interventions. Low prioritization of maternal ART and persistent dropout along the maternal ART cascade were key findings. Service delivery barriers included poor communication and coordination among health system actors, poor clinical practices, and gaps in provider training. The few studies that assessed maternal ART interventions demonstrated the importance of multi-pronged, multi-leveled interventions. There has been a lack of emphasis on the experiences, needs and vulnerabilities particular to HIV-infected pregnant and postpartum women. Supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps. Careful design of integrated service delivery models is of critical importance in this effort. Key knowledge gaps and research priorities were also identified, including definitions and indicators of adherence rates, and the importance of cumulative measures of dropout along the maternal ART cascade.
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DOI：
10.1111/tmi.12072
发表时间：
2013-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Clouse K;Pettifor A;Shearer K;Maskew M;Bassett J;Larson B;Van Rie A;Sanne I;Fox MP
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Fox MP
DOI：
10.1097/qai.0b013e318253258a
发表时间：
2012-07-01
影响因子：
3.6
作者：
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Ross, David A.
影响因子：
4.7
作者：
Dean, Andrea Lach;Makin, Jennifer D.;Forsyth, Brian W. C.
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Forsyth, Brian W. C.
DOI：
10.1097/qai.0b013e31819001a3
发表时间：
2009-02-01
影响因子：
3.6
作者：
Delvaux, Therese;Elul, Batya;Asiimwe, Anita
通讯作者：
Asiimwe, Anita
影响因子：
10.8
作者：
Colvin CJ
通讯作者：
Colvin CJ