Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania.
Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania.
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坦桑尼亚参与预防母婴传播 (PMTCT) 项目的妇女参与产后艾滋病毒护理的预测因素。
DOI：
10.1080/09540121.2018.1550248
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发表时间：
2019
期刊：
影响因子：
1.7
通讯作者：
Mmbaga,BlandinaT
中科院分区：
文献类型：
--
作者：
Watt,MelissaH;Cichowitz,Cody;Kisigo,Godfrey;Minja,Linda;Knettel,BrandonA;Knippler,ElizabethT;Ngocho,James;Manavalan,Preeti;Mmbaga,BlandinaT
预防艾滋病毒母婴传播是艾滋病毒综合治疗方案的基本组成部分。除了预防儿童垂直传播外，防止母婴传播是普遍检测和治疗战略的一个重要切入点，可以减少社区病毒载量并减缓流行病。然而，系统评价表明，在PMTCT方案的护理参与是次优的。这项研究在坦桑尼亚的基利曼哈罗招募了200名开始PMTCT的妇女，并对她们进行了随访，以评估艾滋病毒护理参与度和相关因素。分娩后6个月，42/200（21%）的参与者被确定为护理参与度差，定义为HIV RNA >200拷贝/mL，或者如果病毒载量不可用，则在临床记录中失访或自我报告处于护理状态。 在多变量风险因素分析中，年轻女性更有可能有产后护理参与度差;随着年龄的增长，女性有护理参与度差的可能性降低7%（aRR：0.93; 95% CI：0.89，0.98）。此外，曾告诉至少一个人其艾滋病毒状况的妇女，其护理参与度差的可能性降低了47%（aRR：0.53; 95% CI：0.29，0.97）。在接受产前保健的妇女中，确诊为艾滋病毒的妇女中，首次怀孕的妇女护理参与不良的风险增加（aRR 4.16; 95% CI 1.53，11.28）。研究结果表明，护理参与仍然是一个问题，在预防母婴传播计划，必须加以解决，以实现预防母婴传播的目标。全面的艾滋病毒披露咨询，沿着以社区为基础的减少耻辱感的方案，为艾滋病毒感染者提供一个支持性的环境，是解决护理参与和支持长期治疗的障碍至关重要。接受产前护理的妇女，特别是第一次怀孕的妇女，在分娩前后的关键时期，需要得到护理方面的支持。
Prevention of mother-to-child transmission of HIV (PMTCT) is a foundational component of a comprehensive HIV treatment program. In addition to preventing vertical transmission to children, PMTCT is an important catch-point for universal test-and-treat strategies that can reduce community viral load and slow the epidemic. However, systematic reviews suggest that care engagement in PMTCT programs is sub-optimal. This study enrolled a cohort of 200 women initiating PMTCT in Kilimanjaro, Tanzania, and followed them to assess HIV care engagement and associated factors. Six months after delivery, 42/200 (21%) of participants were identified as having poor care engagement, defined as HIV RNA >200 copies/mL or, if viral load was unavailable, being lost-to-follow-up in the clinical records or self-reporting being out of care. In a multivariable risk factor analysis, younger women were more likely to have poor postpartum care engagement; with each year of age, women were 7% less likely to have poor care engagement (aRR: 0.93; 95% CI: 0.89, 0.98). Additionally, women who had told at least one person about their HIV status were 47% less likely to have poor care engagement (aRR: .53; 95% CI: 0.29, 0.97). Among women who entered antenatal care with an established HIV diagnosis, those who were pregnant for the first time had increased risk of poor care engagement (aRR 4.16; 95% CI 1.53, 11.28). The findings suggest that care engagement remains a concern in PMTCT programs, and must be addressed to realize the goals of PMTCT. Comprehensive counseling on HIV disclosure, along with community-based stigma reduction programs to provide a supportive environment for people living with HIV, are crucial to address barriers to care engagement and support long-term treatment. Women presenting to antenatal care with an established HIV status require support for care engagement during the crucial period surrounding childbirth, particularly those pregnant for the first time.
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