Abstract：
Potential associations between periconception dolutegravir (DTG) exposure and neural tube defects (NTDs) reported in 2018 caused shifting international and national antiretroviral treatment (ART) guidelines. They sometimes required women to use contraception prior to initiating DTG. To better understand the tensions between ART and family planning (FP) choices, and explore the decision-making processes of women living with HIV (WLHIV) and their healthcare providers (HCPs) employed, we conducted interviews with WLHIV exposed to DTG and their providers in western Kenya from July 2019 to August 2020. For the interviews with WLHIV, we sampled women at varying ages who either continued using DTG, switched to a different ART, or became pregnant while using DTG. We utilized inductive coding and thematic analysis. We conducted 44 interviews with WLHIV and 10 with providers. We found four dominant themes: (1) a range of attitudes about birth defects, (2) nuanced knowledge of DTG and its potential risk of birth defects, (3) significant tensions at the intersection of DTG and FP use with varying priorities amongst WLHIV and their providers for navigating the tensions, and (4) WLHIV desiring autonomy, and provider support for this, in such decision-making. Variations in beliefs were noted between WLHIV and HCPs. WLHIV highlighted the impact of community and social beliefs when discussing their attitudes while HCPs generally reported more medicalized views towards DTG utilization, potential adverse outcomes, and FP selection. Decisions pertaining to ART and FP selection are complex, and HIV treatment guidelines need to better support women\'s agency and reproductive health justice.
摘要：
2018年报告的感知dolutegravir（DTG）暴露与神经管缺陷（NTDs）之间的潜在关联导致国际和国家抗逆转录病毒治疗（ART）指南的变化。他们有时要求妇女在开始DTG之前使用避孕药具。为了更好地理解ART和计划生育（FP）选择之间的紧张关系，并探索感染艾滋病毒的妇女（WLHIV）及其雇用的医疗保健提供者（HCP）的决策过程，我们于2019年7月至2020年8月在肯尼亚西部对接触DTG的WLHIV及其提供者进行了访谈.对于WLHIV的采访，我们采样了不同年龄的女性，她们要么继续使用DTG，切换到另一种艺术，或在使用DTG时怀孕。我们利用归纳编码和主题分析。我们对WLHIV进行了44次访谈，对提供者进行了10次访谈。我们发现了四个主要主题：（1）关于出生缺陷的一系列态度，（2）对DTG及其出生缺陷的潜在风险的细致入微的知识，(3)DTG和FP使用的交汇处存在显著的紧张关系，WLHIV及其供应商之间存在不同的优先事项，以应对紧张关系，和(4)WLHIV渴望自治，和提供商对此的支持，在这样的决策中。在WLHIV和HCP之间注意到信念的差异。WLHIV在讨论他们的态度时强调了社区和社会信仰的影响，而HCP通常报告了对DTG利用的更多医学观点，潜在的不良结果，和FP选择。与ART和FP选择有关的决定很复杂，和艾滋病毒治疗指南需要更好地支持妇女机构和生殖健康正义。
