Postpartum Transfer of Care Among HIV-Infected Women Initiating Antiretroviral Therapy During Pregnancy
Postpartum Transfer of Care Among HIV-Infected Women Initiating Antiretroviral Therapy During Pregnancy
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DOI：
10.1097/qai.0000000000000771
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发表时间：
2015-11-01
影响因子：
3.6
通讯作者：
Abrams, Elaine J.
中科院分区：
文献类型：
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作者：
Phillips, Tamsin;McNairy, Margaret L.;Abrams, Elaine J.
背景：将抗逆转录病毒治疗（ART）服务纳入产前护理以预防母婴传播，导致需要在分娩后将艾滋病毒感染妇女转移到普通抗逆转录病毒治疗诊所。在服务之间转移接受 ART 的患者可能会对依从性和保留提出挑战，但很少有数据描述怀孕期间开始 ART 的妇女的 HIV 护理级联中的这一步骤。方法：我们描述了一组在怀孕期间开始 ART 的妇女的产后转移护理，并从综合产前 ART 服务转诊到普通 ART 诊所。通过常规实验室记录和电话访谈评估了一般 ART 诊所对 ART 护理的参与情况。结果：总体而言，有 279 名产后妇女被转移到 ART 诊所。转诊后 5 个月，根据结果定义，74% 至 91% 的女性有参与 ART 诊所的证据。在根据年龄、CD4细胞计数和当前妊娠期间被诊断出感染艾滋病毒的对数二项式模型中，分娩前额外接受抗逆转录病毒治疗几个月可提高参与抗逆转录病毒治疗诊所的可能性（相对风险：1.05，95%置信区间：1.00至1.09，P = 0.036）。结论：产后转移抗逆转录病毒治疗是孕妇艾滋病毒护理级联中重要且以前被忽视的一步。即使在这群高度依从的女性中，仍有高达 25% 的女性在转移后没有继续接受护理。级联的所有步骤都需要保留，包括分娩后转移 ART 护理，以最大限度地发挥 ART 对孕产妇和儿童健康的益处。
Background:The integration of antiretroviral therapy (ART) services into antenatal care for prevention of mother-to-child transmission has resulted in the need to transfer HIV-infected women to general ART clinics after delivery. Transfer of patients on ART between services may present a challenge to adherence and retention, but there are few data describing this step in the HIV care cascade for women starting ART in pregnancy.Methods:We described postpartum transfer of care in a cohort of women initiating ART during pregnancy and referred from integrated antenatal ART services to general ART clinics. Engagement in ART care at general ART clinics was assessed through routine laboratory records and telephonic interviews.Results:Overall, 279 postpartum women were transferred to ART clinics. By 5 months postreferral, between 74% and 91% of women had evidence of engagement at an ART clinic depending on the outcome definition. In a log-binomial model adjusted for age, CD4 cell count and being diagnosed with HIV in the current pregnancy, additional months on ART before delivery improved the likelihood of engagement in an ART clinic (relative risk: 1.05, 95% confidence interval: 1.00 to 1.09, P = 0.036).Conclusions:Postpartum transfer of ART care is an important and previously neglected step in the HIV care cascade for pregnant women. Even in this cohort of highly adherent women up to 25% did not remain in care after transfer. Retention is required across all steps of the cascade, including transfer of ART care after delivery, to maximize the benefits of ART for both maternal and child health.