Healthcare provider knowledge and attitudes about pre-exposure prophylaxis (PrEP) in pregnancy in Cape Town, South Africa.
Healthcare provider knowledge and attitudes about pre-exposure prophylaxis (PrEP) in pregnancy in Cape Town, South Africa.
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DOI：
10.1080/09540121.2020.1782328
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发表时间：
2020-10
期刊：
影响因子：
1.7
通讯作者：
Myer L
中科院分区：
文献类型：
--
作者：
Joseph Davey DL;Daniels J;Beard C;Mashele N;Bekker LG;Dovel K;Ncayiyana J;Coates TJ;Myer L
妊娠期暴露前预防（PrEP）可以降低艾滋病毒的发病率，减少艾滋病毒的垂直传播。医疗保健提供者（HCP）在产前护理中提供PrEP方面发挥着关键作用，但人们对HCP在怀孕期间对PrEP的知识和态度知之甚少。我们在南非开普敦的两家医疗机构进行了一项定性研究，以评估HCP对孕妇艾滋病毒预防的PrEP知识和观点。在2019年1月至3月期间，我们对同意的产前HCP进行了半结构化的深入访谈。我们调查了PrEP经验/观点的五个领域;每次采访都进行了录音和转录。我们采用了一个不断的比较方法，以确定主要的定性结果。我们招募了35名女性HCP（中位年龄=43岁; HCP的中位时间=8年）。不到一半的HCP以前听说过PrEP。在那些听说过PrEP的人中，大多数人认为怀孕期间服用是安全的，尽管有些人不确定。大多数HCP描述了关于有效性的不准确的PrEP知识，并且大多数知道PrEP的人缺乏临床细节。HCP强调了孕产妇使用PrEP的重要潜在障碍，包括：担心PrEP可能不安全，或认为女性在开始PrEP之前必须与伴侣/父母交谈。孕产妇使用PrEP的潜在促进因素包括对血清不一致性和妊娠期血清转化的脆弱性有相对较好的了解，希望帮助女性控制艾滋病毒预防。与孕妇一起工作的HCP对PrEP的了解有限，并对PrEP在妊娠期间的有效性和安全性表示困惑。我们建议将PrEP培训纳入现有的艾滋病毒检测和PMTCT护士培训，并改善产前护理中未感染艾滋病毒的妇女的咨询和PrEP提供。
Pre-exposure prophylaxis (PrEP) in pregnancy can reduce HIV incidence and reduce vertical HIV transmission. Healthcare providers (HCPs) play a critical role in delivering PrEP in antenatal care but little is known about HCP knowledge and attitudes to PrEP in pregnancy. We conducted a qualitative study in two healthcare facilities in Cape Town, South Africa to study to assess HCPs’ PrEP knowledge and perspectives relating to HIV prevention in pregnant women. Between January and March 2019, we administered semi-structured in-depth interviews among consenting antenatal HCPs. We investigated five domains of PrEP experiences/perspectives; each interview was audio-recorded and transcribed. We utilized a constant comparison approach to identify major qualitative findings. We enrolled 35 female HCPs (median age=43; median time as HCP=8 years). Fewer than half of HCPs had heard of PrEP before. Of those who had heard of PrEP, most felt that it was safe to take during pregnancy, though some were unsure. Most HCPs described inaccurate PrEP knowledge regarding effectiveness, and most who knew about PrEP lacked clinical detail. HCPs highlighted important potential barriers to maternal PrEP use including: fear that PrEP may be unsafe, or belief that women must talk to partners/parents before initiating PrEP. Potential facilitators of maternal PrEP use include relatively good knowledge about serodiscordancy and vulnerability to seroconversion in pregnancy, desire to help women gain control over their HIV prevention. HCPs working with pregnant women had limited knowledge about PrEP and expressed confusion about the effectiveness and safety of PrEP in pregnancy. We recommend integrating PrEP training into existing HIV testing and PMTCT nurse training and improve counseling and PrEP delivery for HIV-uninfected women in antenatal care.
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