Determinants of suboptimal adherence and elevated HIV viral load in pregnant women already on antiretroviral therapy when entering antenatal care in Cape Town, South Africa.
Determinants of suboptimal adherence and elevated HIV viral load in pregnant women already on antiretroviral therapy when entering antenatal care in Cape Town, South Africa.
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DOI：
10.1080/09540121.2018.1503637
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发表时间：
2018-12
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：
Brittain K;Remien RH;Mellins CA;Phillips TK;Zerbe A;Abrams EJ;Myer L
在整个撒哈拉以南非洲，预防母婴传播服务遇到了越来越多的妇女在进入产前护理时已经接受抗逆转录病毒治疗(ART)。然而，在这组人中，很少有数据检查ART依从性和HIV病毒载量。我们使用多变量Logistic回归模型来检查进入ART产前护理的妇女中自我报告的次优依从性(定义为在之前30天内错过了≥2天的ART剂量)、病毒载量升高(≥1000拷贝/毫升)以及与每个因素相关的因素。参与者是从开普敦古古莱图的一家初级保健诊所招募的，作为对艾滋病毒阳性孕妇和产后妇女的更大研究的一部分。在2013年5月至2014年6月期间登记的482名接受抗逆转录病毒治疗的孕妇中(中位年龄：31岁；使用抗逆转录病毒药物的中位数：3年)，15%的人报告依从性不佳，12%的人病毒载量增加。在对年龄进行调整后，在未婚/同居的女性和报告对接受抗逆转录病毒治疗的担忧程度较高的女性中，次优依从性明显更常见；坚持自我效能感水平越高，次优依从性的几率就越低。在多变量模型中，病毒载量的升高与既往停止抗逆转录病毒疗法、对服用抗逆转录病毒药物的更高程度的担忧以及意外怀孕的报告显著相关。在已经接受抗逆转录病毒治疗的产前护理的妇女中，依从性不佳和病毒载量增加是很常见的。我们的发现突出了对怀孕期间使用抗逆转录病毒药物的具体信念和关注，这些应该在咨询信息中得到解决，并建议计划生育应该更有效地融入艾滋病毒护理。将依从性和病毒载量监测作为抗逆转录病毒疗法妇女怀孕计划的一部分，对于实现更安全的受孕和促进健康怀孕可能是重要的。
Across sub-Saharan Africa, prevention of mother-to-child transmission services are encountering increasing numbers of women already established on antiretroviral therapy (ART) when entering antenatal care. However, there are few data examining ART adherence and HIV viral load in this group. We used multivariable logistic regression models to examine self-reported suboptimal adherence (defined as missed ART doses on ≥2 days during the preceding 30 days), elevated viral load (≥1000 copies/mL), and factors associated with each among women entering antenatal care on ART. Participants were recruited from one primary care clinic in Gugulethu, Cape Town, as part of a larger study of HIV-positive pregnant and postpartum women. Among 482 pregnant women established on ART and enrolled between May 2013 and June 2014 (median age: 31 years; median duration of ART use: 3 years), 15% reported suboptimal adherence and 12% had elevated viral load. After adjustment for age, suboptimal adherence was significantly more common among women who were not married/cohabiting and women who reported a higher level of concern about taking ART; a higher level of adherence self-efficacy was associated with a reduced odds of suboptimal adherence. In a multivariable model, elevated viral load was significantly associated with previous discontinuation of ART, a higher level of concern about taking ART, and report of an unintended pregnancy. Suboptimal adherence and elevated viral load are common among women entering antenatal care already on ART. Our findings highlight specific beliefs and concerns about ART use during pregnancy that should be addressed in counselling messaging, and suggest that family planning should be more effectively integrated into HIV care. Including adherence and viral load monitoring as part of pregnancy planning for women on ART may be important to achieve safer conception and promote healthy pregnancies.
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作者：
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通讯作者：
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DOI：
10.1097/qai.0000000000000584
发表时间：
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期刊：
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