Health service barriers to HIV testing and counseling among pregnant women attending Antenatal Clinic; a cross-sectional study
Health service barriers to HIV testing and counseling among pregnant women attending Antenatal Clinic; a cross-sectional study
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DOI：
10.1186/1472-6963-14-267
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发表时间：
2014-06-19
影响因子：
2.8
通讯作者：
Addy, Ernestina A.
中科院分区：
文献类型：
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作者：
Kwapong, Golda Dokuaa;Boateng, Daniel;Addy, Ernestina A.
背景：艾滋病毒检测和咨询（HTC）在全球努力实现普遍获得预防和及时的人类免疫缺陷病毒（艾滋病毒）治疗和保健的目标方面仍然至关重要。常规艾滋病毒检测已被证明具有成本效益，可以延长艾滋病毒患者的预期寿命并降低艾滋病毒的年传播率，从而挽救生命。然而，由于卫生设施的相关因素，在产前诊所（ANC）就诊的孕妇中可能看不到常规艾滋病毒检测的这些好处。本文提出卫生设施相关因素对HTC的影响，为HTC的实施提供参考。方法：本研究采用横断面设计，采用结构化问卷和访谈指南收集300名年龄在18 ~ 49岁、参加过两次以上ANC的孕妇的信息。12名卫生工作者作为关键举报人接受了采访。调查对象于2011年8月至11月通过系统随机抽样从库马西大都会的五个城市卫生机构中选出。两次或两次以上ANC就诊后未进行检测的孕妇被归类为未使用HTC。数据用STATA 11进行分析。Logistic回归在95%置信水平下评估优势比。结果：24%的孕妇没有接受过HTC手术，29.5%的受访者表示“从未被告知”是最常见的原因。孕妇决定接受宏达电治疗主要受到以下因素的影响：缺乏信息、对隐私和保密的认识、等待时间、与卫生工作人员关系不佳以及害怕呈阳性反应。结论：仅获得HTC卫生设施并不能转化为对HTC服务的利用。改善卫生设施相关因素，如卫生教育和信息、保密性、卫生工作人员周转时间以及卫生工作人员与客户之间与宏达电有关的关系，将改善执行情况。
Background: HIV testing and counseling (HTC) remains critical in the global efforts to reach a goal of universal access to prevention and timely human immunodeficiency virus (HIV) treatment and health care. Routine HIV testing has been shown to be cost-effective and life-saving by prolonging the life expectancy of HIV patients and reducing the annual HIV transmission rate. However, these benefits of routine HIV testing may not be seen among pregnant women attending antenatal clinic (ANC) due to health facility related factors. This paper presents the influence of health facility related factors on HTC to inform HTC implementation.Methods: The study was cross-sectional in design and used structured questionnaire and interview guides to gather information from 300 pregnant women aged 18 to 49 years and had attended ANC for more than twice at the time of the study. Twelve health workers were interviewed as key informants. Respondents were selected from the five sub metro health facilities in the Kumasi Metropolis through systematic random sampling from August to November 2011. Pregnant women who had not tested after two or more ANC visits were classified as not utilizing HTC. Data was analyzed with STATA 11. Logistic regression was run to assess the odds ratios at 95% confidence level.Results: Twenty-four percent of the pregnant women had not undergone HTC, with "never been told" emerging as the most cited reason as reported by 29.5% of respondents. Decisions by pregnant women to take up HTC were mostly influenced by factors such as lack of information, perceptions of privacy and confidentiality, waiting time, poor relationship with health staff and fear of being positive.Conclusions: Access to HTC health facility alone does not translate into utilization of HTC service. Improving health facility related factors such as health education and information, confidentiality, health staff turnaround time and health staff-client relationship related to HTC will improve implementation.