Kadın Hastalıkları ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum ve Davranışlarının İncelenmesi

Öz

Amaç: HIV (Human Immunodeficiency Virus) (+) gebe yönetiminde, tarama testleri ve viral yük incelemeleri, etkili antiretroviral tedavi, sezaryen ile doğum ve emzirmeden kaçınma en güncel konulardır. Bu çalışmada kadın hastalıkları ve doğum (KD) hekimlerinin HIV (+) gebe yönetimi konusundaki bilgi, tutum ve davranışlarının incelenmesi amaçlanmıştır.

Gereç ve Yöntemler: Demografik bilgiler ve literatürden destek alınarak HIV (+) gebe yönetimine yönelik hazırlanan online/dijital anket ile KD hekimlerine ulaşılarak konu ile alakalı bilgi, tutum ve davranışları belirlenmeye çalışıldı.

Bulgular: Toplam 125 katılımcının 52’si (%41,6) erkek, 86’sı (%68,8) uzman hekim, 13’ü (%10,4) araştırma görevlisi, 34’ü (%27,2) 20 yıl ve üzeri mesleki deneyime sahip, 115’i (%92) gebelerden düzenli olarak Anti-HIV testi istemekte olup 77’sinin (%61,6) en az bir kez Anti-HIV pozitif gebe hastası olmuş, 49’u (%39,2) bugüne kadar Anti-HIV pozitif gebe takibi yapmış, 51’i (%40,8) ise Anti-HIV pozitif en az bir gebeye doğum yaptırmıştı. Hekimlerin 121’i (%96,8) Anti-HIV pozitif gebeleri doğrulama testlerine yönlendirirken 19’u (%15,2) Anti-HIV pozitif anneye emzirmemesi konusunda bilgi vermediğini belirtti. Doğum sırasında HIV RNA düzeyleri >1000 kopya/mL veya viral yükü bilinmeyen Anti-HIV pozitif gebede IV zidovudin uygulanmasının bebeğe bulaş riskini azalttığını bilenler 79 (%63,2) iken HIV (+) anneden doğana profilaksi amaçlı altı hafta zidovudin kullananlar 55’tir (%44). Anti-HIV (+) annenin doğum şekli için “Viral yükü <50 kopya/ml olan gebelerde vajinal doğum yapabilir” diyenler 35 (%28), “Her halükârda sezaryen” diyenler 43’tür (%34,4). Ante, intra ve postpartum dönemlerde Antiretroviral tedavi (ART) ile HIV'in virolojik baskılanmasıyla, yenidoğana perinatal HIV bulaşı %1’lerin altına düşebilir diyenler 47’dir (%37,6).

Sonuç: KD hekimlerine, emzirmeme konusu başta olmak üzere tarama testleri/proflaksi konusu hatırlatılmalı ve eğitimlerin düzenliliği sağlanmalıdır.

Anahtar Kelimeler

• Gebelik,fetal takip,HIV antikorları,bilgi,tutum,tıbbi uygulama yönetimi

Management of HIV Infection during Pregnancy by Gynecologist and Obstetricians

Öz

Aim: In this study, it was aimed to investigate the knowledge, attitudes and behaviors of gynecologists and obstetricians (G/O) during pregnant management in terms of HIV.

Material and Methods: Online questionnaire was reached to G/O physicians to determine relevant knowledge about HIV (+) pregnant management. Information was evaluated by MS Excel.

Results: Of the total 125 participants, 52 (41.6%) were male, 86 (68.8%) were specialist physicians, 13 (10.4%) were research assistants, 34 (27.2%) had 20 years or more professional experience, 115 (92%) of the pregnant women regularly ask for anti-HIV tests, 77 (61.6%) of them had anti-HIV positive pregnant patients at least once, 49 (39.2%) have followed anti-HIV positive pregnant women so far, 51 (40.8%) had given birth to at least one anti-HIV positive pregnant woman. 19 (15.2%) of the physicians didn’t give information to HIV positive mothers not to breastfeed. 79 (63.2%) of those who know that IV zidovudine administration in an HIV positive pregnant with HIVRNA levels> 1000 copies/mL and 55 (44%) of those who use zidovudine for six weeks for prophylaxis. For HIV(+) maternal delivery type, 35 (28%) of those who stated that cesarean section had no advantage in terms of transmission in the pregnant with a viral load <50 copies/ml, and 43 (34.4%) of G/O said that in any case, cesarean section was performed. 47 (37.6%) of physicians said, "If suppression of HIV occurs with ART, the perinatal HIV transmission rate to the newborn may fall below 1%."

Conclusion: Screening tests/prophylaxis especially breastfeeding should be reminded again to O/G physicians and the regularity of these trainings should be ensured.

Anahtar Kelimeler

• Pregnancy,fetal monitoring,HIV antibodies,knowledge,attitude,medical practice management

Kaynakça

1. 1. Jaffar S, Grant AD, Whitworth J, Smith PG, Whittle H. The natural history of HIV–1 and HIV–2 infections in adults in Africa: a literature review. Bull World Health Organ. 2004; 82(6): 462-9.
2. 2. Marlink R, Kanki P, Thior I, Travers K, Eisen G, Siby T et al. Reduced rate of disease development after HIV-2 infection as compared to HIV-1. Science. 1994; 265(5178): 1587-90.
3. 3. Who.int [internet]. HIV/AIDS Data and Statistics [Cited: 25.11.2019]. Available from: https://www.who.int/hiv/data/en/ .
4. 4. Kenyon C. Colebunders R. Voeten H. Lurie M. Peak HIV prevalence: a useful outcome variable for ecological studies. Int J Infect Dis. 2013; 17(5): e286-8.
5. 5. Unaids.org [internet]. Children and HIV Fact sheet [Cited: 25.11.2019]. Available from: https://www.unaids.org/sites/default/files/media_asset/FactSheet_Children_en.pdf.
6. 6. Unaids.org [internet]. UNAIDS 2017 [Cited:25.11.2019]. Available from: https://www.unaids.org/sites/default/files/media_asset/20170720_Data_book_2017_en.pdf.
7. 7. Haas AD, Msukwa MT, Egger M, Tenthani L, Tweya H, Jahn A, et al. Adherence to antiretroviral therapy during and after pregnancy: cohort study on women receiving care in Malawi's option B+ program. Clin Infect Dis. 2016; 63(9): 1227-35.
8. 8. Platten M, Pham HN, Nguyen HV, Nguyen NT, Le GM. Knowledge of HIV and factors associated with attitudes towards HIV among final-year medical students at Hanoi medical university in Vietnam. BMC Public Health. 2014; 14: 265.

9. 9. Hsgm.saglık.gov.tr [internet]. Türkiye HIV/AIDS Kontrol Programı [Erişim tarihi: 29.11.2019]. Erişim adresi: https://hsgm.saglik.gov.tr/tr/bulasici-hastaliklar/hiv-aids/hiv-aids-liste/hiv-aids-tani-tedavi-rehberi.html.
10. 10. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents and pregnant women in health-care settings. Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep. 2006; 55(14): 1-17.
11. 11. Gray AD, Carlson R, Morgan M, Hawks D, Schulkin J. Obstetrician-gynecologists’ knowledge and practice regarding human immunodeficiency virus screening. Obstet Gynecol. 2007; 110(5): 1019-26.
12. 12. McKinney MM, McSpirit S, Pomeroy C. Prenatal HIV prevention practices in a low seroprevalence state. AIDS Educ Prev. 2000; 12(3): 252-62.
13. 13. Olges JR, Murphy BS, Caldwell GG. Thornton AC. Testing practices and knowledge of HIV among prenatal care providers in a low seroprevalence state. AIDS Patient Care STDS. 2007; 21(3): 187-94.
14. 14. Quach L, Mayer K, McGarvey ST, Lurie MN, Do P. Knowledge, attitudes, and practices among physicians on HIV/AIDS in Quang Ninh, Vietnam. AIDS Patient Care STDS. 2005; 19(5): 335-46.
15. 15. Who.int [internet]. Global guidance on criteria and processes for validation: Elimination of mother-to-child transmission of HIV and syphilis. 2nd edition [Cited: 29.11.2019]. Available from: https://www.who.int/reproductivehealth/publications/emtct-hiv-syphilis/en/.
16. 16. Ioannidis JP, Abrams EJ, Ammann A, Bulterys M, Goedert JJ, Gray L, et al. Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/mL. J Infect Dis. 2001; 183(4): 539-45.
17. 17. Massiah E, Roach TC, Jacobs C, St John AM, Inniss V, Walcott J, et al. Stigma, discrimination, and HIV/AIDS knowledge among physicians in Barbados. Rev Panam Salud Publica. 2004; 16(6): 395-401.
18. 18. Aidsinfo.nih.gov [internet]. Panel on antiretroviral therapy and medical management of HIV-Infected children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. [Cited: 29.11.2019]. Available from: http://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf.
19. 19. Centers for Disease Control and Prevention. Revised recommendations for HIV screening of pregnant women. MMWR Recomm Rep. 2001; 50(RR-19):63-85
20. 20. Committee on obstetric practice; HIV expert work group. ACOG committee opinion No. 752: prenatal and perinatal human immunodeficiency virus testing. Obstet Gynecol. 2018; 132(3): e138-42.
21. 21. ACOG committee opinion. Scheduled cesarean delivery and the prevention of vertical transmission of HIV infection. Committee on Obstetric Practice. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1999; 66(3): 305-6.
22. 22. Grimes RM, Courtney CC, Vindekilde J. A collaborative program between a school of public health and a local health department to increase HIV testing of pregnant women. Public Health Rep. 2001; 116(6): 585-9.
23. 23. Burr CK, Storm DS, Gross E. A faculty trainer model: increasing knowledge and changing practice to improve perinatal HIV prevention and care. AIDS Patient Care STDs. 2006; 20(3): 183-92.