Providing HIV Prevention of Mother to Child Transmission (PMTCT) Services to Migrants During the COVID-19 Pandemic in South Africa: Insights of Healthcare Providers.
Providing HIV Prevention of Mother to Child Transmission (PMTCT) Services to Migrants During the COVID-19 Pandemic in South Africa: Insights of Healthcare Providers.
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DOI：
10.1177/11786329211073386
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发表时间：
2022
影响因子：
2.8
通讯作者：
Vearey J
中科院分区：
文献类型：
--
作者：
Bisnauth MA;Coovadia A;Kawonga M;Vearey J
2020年3月，COVID-19进入南非，导致290万例病例，该国采取预防和预防措施控制COVID-19感染的传播。这些措施限制了人口流动，特别是感染艾滋病毒的移民妇女的流动和防止母婴传播服务的提供。本研究的目的是探讨COVID-19大流行对医疗保健提供者提供PMTCT的挑战，并了解移民终身抗逆转录病毒治疗（ART）可以实施哪些策略，以更好地管理该计划。我们与省市各级医疗服务提供者进行了12次深入访谈，探讨新型冠状病毒对医疗系统的改变如何影响高度移动的患者对预防母婴传播服务的依从性和利用率。对新出现的主题进行了主题内容分析，并以“利用预防母婴传播服务”概念框架为指导。会议提出了五个主题：（1）依从性的促进因素和障碍，包括抗逆转录病毒药物（ARV）的长期供应需要数月的配药，以及担心在医院感染COVID-19，中断患者的连续护理;（2）医疗保健提供者的工作环境，参与者对患者的高需求感到不堪重负，缺乏基础设施资源来遵循社交距离协议;（3）财政挑战和机会成本，由于边境关闭和接受治疗所需的文件，防止母婴传播对移民来说很困难，这导致治疗中断，并使许多人因能力限制而无法在设施中获得支持;（4）对移民艾滋病毒感染者存在人际交往、虐待和仇外态度;（5）“计划的可持续性”揭示了三个需要加强的关键领域：延长当天入会咨询的时间，增加技术的使用，以及为移民提供翻译服务。重要的是要吸取在大流行期间学到的经验教训，并将其纳入日常服务提供中，其中包括长期药物供应，以减少多次上门取药的风险，并利用技术减轻患者需求的高负担。需要制定有利于移民包容性和可持续性的医疗保健政策，以更好地将更安全和实用的预防母婴传播方法纳入卫生系统。
In March 2020, COVID-19 entered South Africa, resulting in 2.9 million cases, the country took preventative and precautionary measures to control the spread of COVID-19 infection. These measures limited population mobility especially for migrant women living with HIV (WLWH) and the provision of PMTCT services. The purpose of this research was to explore the challenges of the COVID-19 pandemic on PMTCT provision by healthcare providers and understand what strategies could be implemented with lifelong antiretroviral therapy (ART) for migrants to better manage the program. Twelve in-depth interviews were conducted with healthcare providers across city and provincial levels on how the changes to the healthcare system with COVID-19 affected highly mobile patients’ adherence and utilization of PMTCT services. A thematic content analysis was used for emerging themes and guided by The Utilization of PMTCT Services conceptual framework. Five main themes emerged: (1) Facilitators and barriers to adherence, which included the need for multi-month dispensing for the long term supply of antiretrovirals (ARVs) and the fear of contracting COVID-19 at the hospital that disrupted patients’ continuum of care; (2) Healthcare providers work environment, where participants felt overwhelmed with the high patient demand and the lack of infrastructural resources to follow social distancing protocols; (3) Financial challenges and opportunity costs, PMTCT proved difficult for migrants due to border closures and documentation required to receive care, this resulted in treatment interruption and left many unable to receive support at the facility due to capacity restrictions; (4) Interpersonal interactions, mistreatment, and xenophobic attitudes existed toward the migrant HIV population; and (5) “Program sustainability” revealed three key areas for strengthening: longer duration of time allocated with counseling for same-day initiation, the increased use of technology, and translation services for migrants. It is important to take what was learned during the pandemic and integrate it into routine service delivery, which includes long-term medication supply to reduce risk with multiple visits to collect medication, and the use of technology to alleviate the high-burden of patient demand. Healthcare policies that work toward inclusion and sustainability for migrants are needed to improve the integration of safer and practical methods of PMTCT provision into health systems.