Understanding Antiretroviral Treatment Adherence Among HIV-Positive Women at Four Postpartum Time Intervals: Qualitative Results from the Kabeho Study in Rwanda
Understanding Antiretroviral Treatment Adherence Among HIV-Positive Women at Four Postpartum Time Intervals: Qualitative Results from the Kabeho Study in Rwanda
复制标题
DOI：
10.1089/apc.2016.0234
复制
发表时间：
2017-04-01
影响因子：
4.9
通讯作者：
Bobrow, Emily A.
中科院分区：
文献类型：
--
作者：
Gill, Michelle M.;Umutoni, Aline;Bobrow, Emily A.
随着对孕妇实施终身抗逆转录病毒治疗，了解影响妇女产后坚持抗逆转录病毒治疗的态度和规范非常重要。这是一项定性横断面研究，HIV阳性产后妇女（n=112）在卢旺达参加了为期2年的观察性前瞻性队列。根据理性行动理论（TRA），我们对孩子年龄在0-6、7-12、13-18或21-24个月的妇女进行了深入访谈，以描述影响坚持的因素和随时间的变化。妇女报告的积极抗逆转录病毒疗法态度包括促进母亲健康、预防婴儿感染艾滋病毒、提高CD 4细胞计数和改善外貌。消极的态度很少，但包括副作用和治疗的终身性质。向艾滋病毒感染者（PLHIV）学习被认为是促进依从性的规范;由于害怕在社区和诊所披露或污名化，抗逆转录病毒疗法依从性受到抑制。艾滋病毒诊断后立即出现不良依从行为很常见，而不一定是在预防母婴传播（PMTCT）期间。有较大孩子的妇女，其中大多数在13-18个月内停止母乳喂养，比有较小孩子的妇女报告了更多的障碍和错过的剂量。TRA有助于识别态度、规范和意图对行为的集体影响。研究结果表明，艾滋病毒抗体阳性的妇女容易受到艾滋病毒诊断后和母乳喂养停止的时间差的坚持。终身治疗依从性可以通过艾滋病毒感染者例证长期使用抗逆转录病毒疗法，减少和减少污名化的诊所就诊，以及强调药物对外观和疾病预防的好处并纳入生物反馈的咨询信息来支持。
As lifelong antiretroviral therapy (ART) for pregnant women is implemented, it is important to understand the attitudes and norms affecting women's postpartum ART adherence. This is a qualitative cross-sectional study of HIV-positive postpartum women (n=112) enrolled in a 2-year observational prospective cohort in Rwanda. Informed by the Theory of Reasoned Action (TRA), we conducted in-depth interviews with women whose children were 0-6, 7-12, 13-18, or 21-24 months of age to describe factors contributing to adherence and changes over time. Positive ART attitudes reported by women included mothers' health promotion, prevention of infant HIV infection, higher CD4 count, and improved physical appearance. Negative attitudes were few, but included side effects and the lifelong nature of treatment. Learning from people living with HIV (PLHIV) was identified as a norm facilitating adherence; ART adherence was inhibited by fear of disclosure or stigmatization in communities and clinics. Poor adherence behaviors were common immediately after HIV diagnosis, not necessarily during prevention of mother-to-child transmission (PMTCT). Women with older children, most of whom stopped breastfeeding by 13-18 months, reported more barriers and missed doses than women with younger children. The TRA was useful in identifying the collective influence of attitudes, norms, and intentions on behavior. Findings suggest that HIV-positive women are vulnerable to poor adherence following HIV diagnosis and around the time of breastfeeding cessation. Lifelong treatment adherence can be supported through PLHIV exemplifying long-term ART use, fewer and less stigmatizing clinic visits, and counseling messages highlighting the benefits of drugs on appearance and illness prevention and incorporating biological feedback.