A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women.
A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women.
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DOI：
10.1371/journal.pone.0111421
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Fogg KP
中科院分区：
文献类型：
--
作者：
Hodgson I;Plummer ML;Konopka SN;Colvin CJ;Jonas E;Albertini J;Amzel A;Fogg KP
尽管在降低孕产妇死亡率方面取得了进展，但与艾滋病毒有关的孕产妇死亡率仍然很高，例如在撒哈拉以南非洲，占所有与妊娠有关的死亡人数的24%。抗逆转录病毒治疗（ART）在改善HIV感染孕妇和产后妇女的结局方面是有效的，但启动率、依从率和保留率仍然很低。这篇系统性文献综述综合了影响艾滋病毒感染孕妇和产后妇女使用抗逆转录病毒疗法的个人和背景因素的证据。对涉及人群（感染HIV的孕妇和产后妇女）、干预（ART）和关注结果（开始、依从和保留）的研究进行了回顾性分析。包括自2008年1月以来以英文发表的定量和定性研究。提取和组织的个人，人际，社区和结构类别的框架内的主题，个人和上下文的使能因素和使用抗逆转录病毒治疗的障碍。34项研究被纳入审查。个人层面的因素包括女性意识和控制范围内和范围外的因素（例如，对儿童健康或年龄的承诺）。个人层面的障碍包括对艾滋病毒，抗逆转录病毒治疗，预防母婴传播的认识不足，以及难以管理抗逆转录病毒治疗的实际需求。在人际层面上，向配偶披露和配偶参与治疗与改善启动，坚持和保留相关。害怕负面后果是披露的一个障碍。在社区一级，成见是一个主要障碍。关键的结构性障碍和促进因素与卫生系统的使用和参与有关，包括获得服务的机会和卫生工作者的态度。为了取得成功，通过整合孕产妇保健和艾滋病毒服务来扩大获得和持续使用抗逆转录病毒治疗的方案必须在本审查中描述的各自背景下确定和解决相关障碍和促进因素。需要对这一人群，包括辍学或从未获得保健服务的人群进行进一步研究，以便为有效实施提供信息。
Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories. Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman’s awareness and control (e.g., commitment to child’s health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation.
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影响因子：
56.3
作者：
Baernighausen, Till;Chaiyachati, Krisda;Chimbindi, Natsayi;Peoples, Ashleigh;Haberer, Jessica;Newell, Marie-Louise
通讯作者：
Newell, Marie-Louise
影响因子：
4.7
作者：
Dean, Andrea Lach;Makin, Jennifer D.;Forsyth, Brian W. C.
通讯作者：
Forsyth, Brian W. C.
DOI：
10.1097/qai.0b013e31819001a3
发表时间：
2009-02-01
影响因子：
3.6
作者：
Delvaux, Therese;Elul, Batya;Asiimwe, Anita
通讯作者：
Asiimwe, Anita
DOI：
10.1097/qai.0b013e31817bbe80
发表时间：
2008-08-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Bardeguez AD;Lindsey JC;Shannon M;Tuomala RE;Cohn SE;Smith E;Stek A;Buschur S;Cotter A;Bettica L;Read JS;PACTG 1025 Protocol Team
通讯作者：
PACTG 1025 Protocol Team
影响因子：
6
作者：
Ayuo, Paul;Musick, Beverly;Wools-Kaloustian, Kara
通讯作者：
Wools-Kaloustian, Kara