Health system challenges affecting the implementation of isoniazid preventive therapy in people living with HIV in Lesotho
Health system challenges affecting the implementation of isoniazid preventive therapy in people living with HIV in Lesotho
复制标题
DOI：
10.5114/hivar.2018.80263
复制
发表时间：
2018-01-01
影响因子：
0.2
通讯作者：
van den Heever, Wilhelmiena M.
中科院分区：
文献类型：
--
作者：
Mugomeri, Eltony;Olivier, Dedre;van den Heever, Wilhelmiena M.
简介：六个月疗程的异烟肼预防性治疗（IPT）已被证明在减少结核病（TB）的发生方面具有显著的益处，特别是在高TB负担环境中。然而，由于不明确的原因，该倡议在撒哈拉以南国家的实施仍然受到抑制。本研究调查的因素，抑制IPT吸收在撒哈拉以南的国家莱索托，其中有一个最高的结核病发病率global.Material和方法：数据来自46名医护人员，在莱索托卫生部的主要线人，和合作伙伴组织的代表，他们的作用，有目的地选择在IPT实施。对数据进行编码，以确定主题，并将新出现的主题与以前的类型学进行比较，以评价卫生干预措施中最佳做法的实施情况，即有效性、覆盖范围、可持续性和适应性。每一个主要主题都进一步与世界卫生组织的“卫生系统的六个组成部分”联系起来。结果：影响实施国际预防和治疗的挑战如下：由于人类免疫缺陷病毒（艾滋病毒）/结核病服务的分散化受到挑战，结核病筛查效果不佳，与监测系统薄弱有关的副作用发现较晚，以及卫生信息系统效率低下。卫生系统面临的进一步挑战包括由于卫生系统资金不足而造成供应链中断，同时还注意到卫生保健工作者在实施因特网预防和治疗方面的教育不足。这些调查结果表明，一系列广泛的挑战影响了在莱索托实施IPT，这表明莱索托和其他面临类似挑战的国家需要采取“卫生系统办法”来实施IPT。
Introduction: The six-month course of isoniazid preventive therapy (IPT) has been demonstrated to have significant benefits in mitigating the occurrence of tuberculosis (TB), particularly in high TB burden settings. However, its implementation in Sub-Saharan countries remains subdued for obscure reasons. This study investigated the factors inhibiting IPT uptake in the sub-Saharan country of Lesotho, which has one of the highest rates of TB incidences globally.Material and methods: Data were obtained from 46 healthcare workers, key informants at the Ministry of Health of Lesotho, and representatives of partner organizations, who were purposively selected for their roles in IPT implementation. Data were coded to identify themes, and the emerging themes were benchmarked to previous typologies for evaluating the implementation of best practices in health interventions, namely effectiveness, reach, sustainability, and adaptation. Each major theme was further linked to the World Health Organization's 'six building blocks of a health system.Results: Challenges affecting the implementation of IPT were as follows: ineffective TB screening due to challenged decentralization of human immunodeficiency virus (HIV)/TB services, late detection of side effects linked to weak monitoring systems, and inefficient health information systems. Further challenges in the health system included interrupted supply chains due to insufficient health system financing, while inadequate healthcare workers education on IPT implementation was also noted.Conclusions: These findings indicate that a wide spectrum of challenges has affected the implementation of IPT in Lesotho, and this indicates the need for 'health systems approach' to the implementation of IPT in Lesotho and other countries with similar challenges.