Protocol for a prospective evaluation of postpartum engagement in HIV care among women living with HIV in South Africa.
Protocol for a prospective evaluation of postpartum engagement in HIV care among women living with HIV in South Africa.
复制标题
南非艾滋病毒感染妇女产后参与艾滋病毒护理的前瞻性评估方案。
DOI：
10.1136/bmjopen-2019-035465
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发表时间：
2020
期刊：
影响因子：
2.9
通讯作者：
Smit,JenniferA
中科院分区：
文献类型：
--
作者：
Psaros,Christina;Stanton,AmeliaM;Bedoya,CAndres;Mosery,Nzwakie;Evans,Shannon;Matthews,LynnTurner;Haberer,Jessica;Vangel,Mark;Safren,Steven;Smit,JenniferA
南非夸祖鲁-纳塔尔省（KZN）是世界上感染艾滋病毒的孕妇发病率最高的地区。怀孕和产后期间为妇女提供了参与艾滋病毒护理、预防围产期传播和优化母婴福祉的机会。然而，研究表明，在这段时间内，仍然从事艾滋病毒护理可能是具有挑战性的。方法和analysisWe正在进行一项为期5年的前瞻性队列研究，在KZN感染艾滋病毒的孕妇估计率和相关因素与艾滋病毒护理的磨损在这一关键时期。为了确定谁最有可能失去护理，我们正在研究一系列相关变量，这些变量由艾滋病毒护理的社会生态模型提供信息，包括个人，关系，社区和医疗保健系统变量。我们正在招募怀孕28周或更长时间的18-45岁妇女，她们感染了艾滋病毒，目前正在接受抗逆转录病毒治疗。参与者在基线（妊娠）和产后6，12，18和24个月完成定量评估。邀请一部分妇女及其伴侣完成定性访谈，以进一步探讨她们在艾滋病毒护理方面的经验。主要研究结果是抑制HIV RNA和在每次研究评估时保持护理。我们的理解的因素，驱动产后自然减员从艾滋病护理将最终通知干预措施的发展，以促进产后艾滋病护理的持续参与。伦理和disseminationThis协议已被批准的人类研究伦理委员会（医学）在威特沃特斯兰德大学（约翰内斯堡，SA）和合作伙伴人类研究委员会在合作伙伴医疗保健（波士顿，马萨诸塞州，美国）。研究中心获得了地区医院和KZN省卫生厅的支持和批准。研究结果将通过同行评审的手稿、报告以及当地和国际演示文稿（伦理注册编号170 212）进行传播。
IntroductionKwaZulu-Natal (KZN), South Africa (SA) has the highest prevalence of pregnant women living with HIV in the world. Pregnancy and the postpartum period offer opportunities to engage women in HIV care, to prevent perinatal transmission and to optimise maternal and infant well-being. However, research suggests that remaining engaged in HIV care during this time can be challenging.Methods and analysisWe are conducting a 5-year prospective cohort study among pregnant women living with HIV in KZN to estimate the rates and factors associated with attrition from HIV care during this critical period. To determine who is most likely to fall out of care, we are examining a range of relevant variables informed by a socioecological model of HIV care, including individual, relational, community and healthcare system variables. We are enrolling 18–45-year-old women, at 28 weeks or more of pregnancy, who are living with HIV and currently taking antiretroviral therapies. Participants complete quantitative assessments at baseline (pregnancy) and at 6, 12, 18 and 24 months postpartum. A subset of women and their partners are invited to complete qualitative interviews to further explore their experiences in HIV care. The main study outcomes are suppressed HIV RNA and retention in care at each study assessment. Our understanding of the factors that drive postpartum attrition from HIV care will ultimately inform the development of interventions to facilitate continued engagement in postpartum HIV care.Ethics and disseminationThis protocol has been approved by the Human Research Ethics Committee (Medical) at The University of the Witwatersrand (Johannesburg, SA) and the Partners Human Research Committee at Partners HealthCare (Boston, Massachusetts, USA). Site support and approval were obtained from the District Hospital and the KZN Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations (Ethics Registration #170 212).