Stigma, Facility Constraints, and Personal Disbelief: Why Women Disengage from HIV Care During and After Pregnancy in Morogoro Region, Tanzania.
Stigma, Facility Constraints, and Personal Disbelief: Why Women Disengage from HIV Care During and After Pregnancy in Morogoro Region, Tanzania.
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DOI：
10.1007/s10461-016-1505-8
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发表时间：
2017-01
影响因子：
4.4
通讯作者：
Kilewo, Charles
中科院分区：
文献类型：
--
作者：
McMahon, Shannon A.;Kennedy, Caitlin E.;Winch, Peter J.;Kombe, Miriam;Killewo, Japhet;Kilewo, Charles
关键词：
撒哈拉以南非洲有数百万儿童感染艾滋病毒，这些儿童感染的主要方式是母婴传播。虽然现有的干预措施实际上可以消除这种传播，但在低收入和中等收入环境中，只有63%感染艾滋病毒的孕妇获得了预防传播所需的药物。在坦桑尼亚，孕妇的艾滋病毒感染率为3.2%。了解艾滋病毒阳性妇女在怀孕期间和怀孕后脱离护理的原因可以为减少艾滋病毒对母亲和幼儿的影响的努力提供信息。根据扎根理论的原则，我们对40名血清阳性的产后妇女进行了定性访谈，这些妇女已经脱离了预防母婴传播（PMTCT）的护理。几乎所有妇女都认为抗逆转录病毒治疗（ART）最终是有益的，但由于对耻辱的担忧，实际上无法获得。许多妇女还描述了她们对健康和活力的感觉以及对副作用的担忧如何强调了放弃抗逆转录病毒治疗的愿望，直到她们认为立即有必要。相对较少的妇女表示不知道或忘记她们需要继续治疗方案。我们提出了一种预防母婴传播脱离接触的理论，概述了主要和辅助障碍。这项研究是第一批通过采访实际上已经停止护理的女性来检查脱离工作的研究之一。我们敦促在坦桑尼亚的环境中调整、实施和评估诸如母亲对母亲支持小组、当日追踪的电子医疗记录、任务转移和移动技术等干预方法的组合。
Millions of children are living with HIV in sub-Saharan Africa, and the primary mode of these childhood infections is mother-to-child transmission. While existing interventions can virtually eliminate such transmission, in low- and middle-income settings, only 63% of pregnant women living with HIV accessed medicines necessary to prevent transmission. In Tanzania, HIV prevalence among pregnant women is 3.2%. Understanding why HIV-positive women disengage from care during and after pregnancy can inform efforts to reduce the impact of HIV on mothers and young children. Informed by the tenets of Grounded Theory, we conducted qualitative interviews with 40 seropositive postpartum women who had disengaged from care to prevent mother-to-child transmission (PMTCT). Nearly all women described antiretroviral treatment (ART) as ultimately beneficial but effectively inaccessible given concerns related to stigma. Many women also described how their feelings of health and vitality coupled with concerns about side effects underscored a desire to forgo ART until they deemed it immediately necessary. Relatively fewer women described not knowing or forgetting that they needed to continue their treatment regimens. We present a theory of PMTCT disengagement outlining primary and ancillary barriers. This study is among the first to examine disengagement by interviewing women who had actually discontinued care. We urge that a combination of intervention approaches such as mother-to-mother support groups, electronic medical records with same-day tracing, task shifting, and mobile technology be adapted, implemented, and evaluated within the Tanzanian setting.
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1097/qai.0b013e3182055138
发表时间：
2011-02-01
影响因子：
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作者：
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通讯作者：
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