Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania
Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania
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DOI：
10.1371/journal.pone.0021020
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发表时间：
2011-06-10
期刊：
影响因子：
3.7
通讯作者：
Theuring, Stefanie
中科院分区：
文献类型：
--
作者：
Kirsten, Inga;Sewangi, Julius;Theuring, Stefanie
背景：自 2008 年以来，坦桑尼亚预防艾滋病毒母婴传播 (PMTCT) 指南建议从妊娠第 28 周开始对母亲和婴儿采用联合治疗方案。与单一药物干预措施相比，联合预防被认为更有效且不易形成耐药性，但所需的持续收集和摄入药物可能会对依从性构成挑战，特别是在外围资源有限的环境中。本研究旨在分析坦桑尼亚 Kyela 农村卫生机构在现场条件下对联合预防的依从性。方法和结果：Kyela 地区医院的 122 名愿意开始联合预防的孕妇参加了一项观察性研究。确定了预防治疗下降的危险因素，并计算了分娩前、分娩期间和分娩后的依从性水平。在多变量分析中，确定的产前预防下降的危险因素包括孕产妇年龄低于 24 岁、没有创收活动以及在 24.5 孕周之前入组，比值比分别为 5.8 (P = 0.002)、4.4 (P = 0.015) 和 7.8 (P = 0.001)。声称已披露艾滋病毒感染状况的女性在分娩前的依从性显着高于未披露的女性 (P = 0.004)。在产中和产后期间，住院期间药物依从率相当低，表明工作人员的表现不令人满意。在所有干预阶段，只有 10 对母子的依从率至少达到 80%；一对单母子达到了 95% 的依从性阈值。 结论：在这一农村研究环境中，实现联合预防的依从性具有挑战性。我们的研究结果强调需要对预防母婴传播工作人员以及客户进行额外的监督，特别是鼓励他们通过身份披露寻求社会支持。通过将药物摄入提前到较早的胎龄，可以提高预防药物的吸收。在实施 PMTCT 联合预防时，应认真考虑医疗保健环境的有限结构条件。
Background: Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania.Methods and Findings: A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002), 4.4 (P = 0.015) and 7.8 (P = 0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004). In the intra-and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold.Conclusions: Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis.