INTRODUCTION:KwaZulu-Natal (KZN), South Africa (SA) has the highest prevalence of pregnant women living with HIV in the world. Pregnancy and the postpartum period offer opportunities to engage women in HIV care, to prevent perinatal transmission and to optimise maternal and infant well-being. However, research suggests that remaining engaged in HIV care during this time can be challenging. METHODS AND ANALYSIS:We are conducting a 5-year prospective cohort study among pregnant women living with HIV in KZN to estimate the rates and factors associated with attrition from HIV care during this critical period. To determine who is most likely to fall out of care, we are examining a range of relevant variables informed by a socioecological model of HIV care, including individual, relational, community and healthcare system variables. We are enrolling 18-45-year-old women, at 28 weeks or more of pregnancy, who are living with HIV and currently taking antiretroviral therapies. Participants complete quantitative assessments at baseline (pregnancy) and at 6, 12, 18 and 24 months postpartum. A subset of women and their partners are invited to complete qualitative interviews to further explore their experiences in HIV care. The main study outcomes are suppressed HIV RNA and retention in care at each study assessment. Our understanding of the factors that drive postpartum attrition from HIV care will ultimately inform the development of interventions to facilitate continued engagement in postpartum HIV care. ETHICS AND DISSEMINATION:This protocol has been approved by the Human Research Ethics Committee (Medical) at The University of the Witwatersrand (Johannesburg, SA) and the Partners Human Research Committee at Partners HealthCare (Boston, Massachusetts, USA). Site support and approval were obtained from the District Hospital and the KZN Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations (Ethics Registration #170 212).

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简介:南非夸祖鲁-纳塔尔省(KZN)的艾滋病毒感染孕妇患病率最高。怀孕和产后提供了使妇女参与艾滋病毒预防,防止围产期传播以及优化母婴健康的机会。但是,研究表明,在这段时间内继续从事HIV护理可能是一个挑战。
方法和分析:我们正在KZN中对感染HIV的孕妇进行为期5年的前瞻性队列研究,以评估在此关键时期与HIV减员有关的比率和因素。为了确定谁最有可能失去医疗保健,我们正在研究一系列由HIV保健的社会生态学模型告知的相关变量,包括个人,亲属,社区和医疗保健系统变量。我们正在招募怀孕28周或以上的18-45岁妇女,她们感染了HIV,目前正在接受抗逆转录病毒疗法。参与者在基线(怀孕)以及产后6、12、18和24个月时完成定量评估。邀请一部分妇女及其伴侣完成定性访谈,以进一步探讨她们在艾滋病毒护理方面的经验。主要研究结果是抑制HIV RNA和在每次研究评估中保持治疗。我们对导致产后艾滋病毒减员的因素的理解最终将为干预措施的发展提供信息,以促进持续参与产后艾滋病毒的治疗。
道德与传播:本协议已获得威特沃特斯兰德大学(约翰内斯堡,南卡罗来纳州)的人类研究伦理委员会(医学)和Partners HealthCare(美国马萨诸塞州波士顿)的合作伙伴人类研究委员会的批准。现场支持和批准是从地区医院和KZN省卫生部门获得的。结果将通过同行评审的手稿,报告以及本地和国际演示进行传播(道德注册号170 212)。

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