Women's Preferences Regarding Infant or Maternal Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission of HIV during Breastfeeding and Their Views on Option B plus in Dar es Salaam, Tanzania
Women's Preferences Regarding Infant or Maternal Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission of HIV during Breastfeeding and Their Views on Option B plus in Dar es Salaam, Tanzania
复制标题
DOI：
10.1371/journal.pone.0085310
复制
发表时间：
2014-01-22
期刊：
影响因子：
3.7
通讯作者：
Ekstrom, Anna Mia
中科院分区：
文献类型：
--
作者：
Ngarina, Matilda;Tarimo, Edith A. M.;Ekstrom, Anna Mia
背景资料：世卫组织2010年关于预防艾滋病毒母婴传播的指南建议，在低收入国家，对于CD 4计数>350个细胞/μ L的孕妇，在母乳喂养期间对婴儿（选项A）或母亲（选项B）进行预防性抗逆转录病毒治疗。2012年，世卫组织提议，所有感染艾滋病毒的孕妇应接受终身三联抗逆转录病毒疗法（B+），无论其CD 4细胞计数如何。坦桑尼亚最近从选项A转向B+，少数中心实行B。然而，需要更多关于这些选择在现实生活中的可行性的信息。这项定性研究探讨了妇女对选项A与B的偏好以及她们对选项B+的看法在坦桑尼亚达累斯萨拉姆。方法：我们进行了四个焦点小组讨论，共有27名孕妇与未知的艾滋病毒状态，参加生殖和儿童健康诊所，并在艾滋病毒感染的孕妇和产后妇女中进行了31次深入访谈，其中17人还被问及B+。与A相比，大多数参与者更倾向于选择B。选择方案B的主要原因是：艾滋病毒相关的耻辱，担心药物对婴儿的副作用和产后药物依从性的困难后勤。一些被问及B+的妇女赞成它，因为她们同意，为了自己的生存，她们最终将需要ART。有些人反对B+，认为在保护孩子后会失去动力，担心药物的副作用，也没有准备好终身服药。结论：备选方案B更可取。由于坦桑尼亚最近采用了方案B+，应向CD 4计数>350个细胞/μ L的妇女提供咨询，告知其在停止母乳喂养后“选择退出”抗逆转录病毒疗法的可能性。在B+实施过程中，应解决药物安全性和获益、经济问题以及实验室监测和评价的可用资源，以提高长期可行性和有效性。
Background: The WHO 2010 guidelines for prevention of mother-to-child transmission (PMTCT) of HIV recommended prophylactic antiretroviral treatment (ART) either for infants (Option A) or mothers (Option B) during breastfeeding for pregnant women with a CD4 count of >350 cell/mu L in low-income countries. In 2012, WHO proposed that all HIV-infected pregnant women should receive triple ART for life (B+) irrespective of CD4 count. Tanzania has recently switched from Option A to B+, with a few centers practicing B. However, more information on the real-life feasibility of these options is needed. This qualitative study explored women's preferences for Option A vs B and their views on Option B+ in Dar es Salaam, Tanzania.Methods: We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+.Results: Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided.Conclusion: Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/mu L should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness.