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

Yıl 2020, Cilt: 10 Sayı: 2, 223 - 227, 31.05.2020
https://doi.org/10.33631/duzcesbed.664720

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.

Kaynakça

  • 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. 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. Who.int [internet]. HIV/AIDS Data and Statistics [Cited: 25.11.2019]. Available from: https://www.who.int/hiv/data/en/ .
  • 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. 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. 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. 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. 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. 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. 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. 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. McKinney MM, McSpirit S, Pomeroy C. Prenatal HIV prevention practices in a low seroprevalence state. AIDS Educ Prev. 2000; 12(3): 252-62.
  • 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. 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. 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. 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. 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. 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. Centers for Disease Control and Prevention. Revised recommendations for HIV screening of pregnant women. MMWR Recomm Rep. 2001; 50(RR-19):63-85
  • 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. 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. 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. 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.

Management of HIV Infection during Pregnancy by Gynecologist and Obstetricians

Yıl 2020, Cilt: 10 Sayı: 2, 223 - 227, 31.05.2020
https://doi.org/10.33631/duzcesbed.664720

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.

Kaynakça

  • 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. 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. Who.int [internet]. HIV/AIDS Data and Statistics [Cited: 25.11.2019]. Available from: https://www.who.int/hiv/data/en/ .
  • 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. 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. 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. 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. 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. 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. 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. 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. McKinney MM, McSpirit S, Pomeroy C. Prenatal HIV prevention practices in a low seroprevalence state. AIDS Educ Prev. 2000; 12(3): 252-62.
  • 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. 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. 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. 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. 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. 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. Centers for Disease Control and Prevention. Revised recommendations for HIV screening of pregnant women. MMWR Recomm Rep. 2001; 50(RR-19):63-85
  • 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. 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. 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. 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.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Mustafa Altındiş 0000-0003-0411-9669

Hilal Uslu Yuvacı 0000-0001-8067-3165

Hande Toptan 0000-0001-6893-8490

Tuğba Kaya 0000-0003-2017-481X

Serhan Cevrioğlu 0000-0002-3810-6519

Oğuz Karabay

Yayımlanma Tarihi 31 Mayıs 2020
Gönderilme Tarihi 25 Aralık 2019
Yayımlandığı Sayı Yıl 2020 Cilt: 10 Sayı: 2

Kaynak Göster

APA Altındiş, M., Uslu Yuvacı, H., Toptan, H., Kaya, T., vd. (2020). Kadın Hastalıkları ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum ve Davranışlarının İncelenmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 10(2), 223-227. https://doi.org/10.33631/duzcesbed.664720
AMA Altındiş M, Uslu Yuvacı H, Toptan H, Kaya T, Cevrioğlu S, Karabay O. Kadın Hastalıkları ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum ve Davranışlarının İncelenmesi. DÜ Sağlık Bil Enst Derg. Mayıs 2020;10(2):223-227. doi:10.33631/duzcesbed.664720
Chicago Altındiş, Mustafa, Hilal Uslu Yuvacı, Hande Toptan, Tuğba Kaya, Serhan Cevrioğlu, ve Oğuz Karabay. “Kadın Hastalıkları Ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum Ve Davranışlarının İncelenmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10, sy. 2 (Mayıs 2020): 223-27. https://doi.org/10.33631/duzcesbed.664720.
EndNote Altındiş M, Uslu Yuvacı H, Toptan H, Kaya T, Cevrioğlu S, Karabay O (01 Mayıs 2020) Kadın Hastalıkları ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum ve Davranışlarının İncelenmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 2 223–227.
IEEE M. Altındiş, H. Uslu Yuvacı, H. Toptan, T. Kaya, S. Cevrioğlu, ve O. Karabay, “Kadın Hastalıkları ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum ve Davranışlarının İncelenmesi”, DÜ Sağlık Bil Enst Derg, c. 10, sy. 2, ss. 223–227, 2020, doi: 10.33631/duzcesbed.664720.
ISNAD Altındiş, Mustafa vd. “Kadın Hastalıkları Ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum Ve Davranışlarının İncelenmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10/2 (Mayıs 2020), 223-227. https://doi.org/10.33631/duzcesbed.664720.
JAMA Altındiş M, Uslu Yuvacı H, Toptan H, Kaya T, Cevrioğlu S, Karabay O. Kadın Hastalıkları ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum ve Davranışlarının İncelenmesi. DÜ Sağlık Bil Enst Derg. 2020;10:223–227.
MLA Altındiş, Mustafa vd. “Kadın Hastalıkları Ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum Ve Davranışlarının İncelenmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 10, sy. 2, 2020, ss. 223-7, doi:10.33631/duzcesbed.664720.
Vancouver Altındiş M, Uslu Yuvacı H, Toptan H, Kaya T, Cevrioğlu S, Karabay O. Kadın Hastalıkları ve Doğum Hekimlerinin HIV (+) Gebe Yönetimindeki Bilgi, Tutum ve Davranışlarının İncelenmesi. DÜ Sağlık Bil Enst Derg. 2020;10(2):223-7.