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Acceptability and challenges of rapid ART initiation among pregnant women in a pilot programme, Cape Town, South Africa

机译：在南非开普敦的一项试点计划中，孕妇快速启动抗逆转录病毒疗法的可接受性和挑战

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Maternal antiretroviral therapy (ART) is a critical intervention in the prevention-of-mother-to child transmission (PMTCT) of HIV. In South Africa, many HIV-infected pregnant women commence ART late in pregnancy, and as a result, the duration of ART prior to delivery is often insufficient to prevent vertical transmission. To address this, we designed an intervention for the rapid initiation of ART in pregnancy (RAP), where patient's ART preparation occurred during rather than before treatment commencement. Here we report on the acceptability and the challenges of the RAP programme. We conducted 7 key informant and 27 semi-structured interviews with RAP participants. Participants were purposefully selected based on ART-eligibility and stage in the pregnancy to post-partum continuum. Interviews were conducted in participants' home language by trained fieldworkers, with key informant interviews conducted by the study investigators. The data were analysed using a framework analysis approach. Rapid initiation in pregnancy was acceptable to the majority of programme participants and protection of the woman's unborn child was the primary motivation for starting treatment. The key barrier was the limited time to accept the dual challenges of being diagnosed HIV-positive and eligible for life-long ART. Truncated time also limited the opportunity for disclosure to others. Despite these and other barriers, most women found the benefits of rapid ART commencement outweighed the challenges, with 91% of women initiated onto ART starting the same day treatment eligibility was determined. Many participants and key informants identified the importance of counseling and the need to make an informed, independent choice on the timing of ART initiation, based on individual circumstances. Acceptance of ART-eligibility improved with time on the programme, however, as women's principal reason for initiating ART was protection of the unborn child, monitoring and supporting adherence during the post-partum period will be critical.
机译：孕产妇抗逆转录病毒疗法（ART）是预防HIV母婴传播（PMTCT）的关键干预措施。在南非，许多受HIV感染的孕妇在怀孕后期开始抗病毒治疗，结果，分娩前抗病毒治疗的持续时间通常不足以防止垂直传播。为了解决这个问题，我们设计了一种干预措施，以快速启动妊娠ART（RAP），即在治疗开始前而不是治疗开始前进行患者的ART制备。在这里，我们报告了RAP计划的可接受性和挑战。我们对RAP参与者进行了7次关键信息提供者和27次半结构化访谈。根据抗逆转录病毒治疗的资格和妊娠至产后连续性的阶段有针对性地选择参与者。访谈由受过训练的现场工作人员以参与者的母语进行，访谈由研究调查人员进行。使用框架分析方法分析数据。计划的大多数参与者都可以接受怀孕的迅速开始，而保护妇女未出生的孩子是开始治疗的主要动机。关键的障碍是在有限的时间内接受被诊断为HIV阳性和获得终身抗病毒治疗资格的双重挑战。截断的时间也限制了向他人公开的机会。尽管有这些和其他障碍，大多数妇女发现快速开始抗逆转录病毒疗法的益处胜过挑战，确定了在同一天开始接受抗逆转录病毒疗法的妇女中有91％开始接受抗逆转录病毒疗法。许多参与者和关键信息提供者确定了咨询的重要性以及需要根据个人情况在抗病毒治疗的开始时间做出知情的，独立的选择。该计划对接受抗逆转录病毒疗法资格的接受程度随着时间的推移而提高，但是，由于妇女发起抗逆转录病毒疗法的主要原因是对未出生婴儿的保护，因此在产后监测和支持依从性至关重要。

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