Supply-side dimensions and dynamics of integrating HIV testing and counselling into routine antenatal care: a facility assessment from Morogoro Region, Tanzania
Supply-side dimensions and dynamics of integrating HIV testing and counselling into routine antenatal care: a facility assessment from Morogoro Region, Tanzania
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DOI：
10.1186/s12913-015-1111-x
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发表时间：
2015-10-04
影响因子：
2.8
通讯作者：
Kilewo, Charles
中科院分区：
文献类型：
--
作者：
An, Selena J.;George, Asha S.;Kilewo, Charles
背景资料：将艾滋病毒纳入生殖、孕产妇、新生儿和儿童保健服务是解决撒哈拉以南非洲母亲和儿童艾滋病毒负担过重问题的一个重要进程。我们评估了在常规产前护理中支持艾滋病毒检测和咨询的结构性投入和护理过程，以了解在坦桑尼亚艾滋病毒政策最近发生变化之前，对进一步将艾滋病毒纳入RMNCH服务至关重要的供应方动态。这项研究是坦桑尼亚莫罗戈罗地区孕产妇和新生儿健康项目评估的一部分，从18个设施检查表，65个定量和57个定性提供者访谈和203个产前护理观察的卫生中心评估得出。定量数据使用Stata 12.0进行了描述性分析，定性数据进行了专题分析与Atlas.ti.Results管理的数据：结构性投入，如基础设施，用品和人员配置的限制，限制了艾滋病毒检测和咨询纳入常规产前保健服务的潜力。虽然对包括等候区在内的基础设施的评估似乎是充分的，但排长队和房间狭小使妇女个人难以进行私人和保密的艾滋病毒检测和咨询。艾滋病毒检测试剂盒、基本药物和预防感染设备的库存不可靠也影响到医患关系，据报告，妇女到保健中心寻求护理的人数减少。此外，据报告，人员配置水平低增加了工作量，降低了卫生工作者的积极性。尽管对咨询信息有足够的了解，但产前咨询时间很短，向孕妇传达的信息不完整。此外，应对机制，如调度的临床活动在不同的日子，有限的服务availability.Conclusion：产前护理是一个战略切入点，提供关键的测试和咨询的信息和病人与供应商的关系，这共同支持护理寻求其余的连续性的护理框架。在产前护理期间提供艾滋病毒检测和咨询的结构性投入和程序方面的供应不足表明，所提供的护理质量存在严重缺陷。如果要将艾滋病毒检测和咨询纳入产前护理，改善孕产妇和新生儿的健康结果，就必须解决这些问题。
Background: Integration of HIV into RMNCH (reproductive, maternal, newborn and child health) services is an important process addressing the disproportionate burden of HIV among mothers and children in sub-Saharan Africa. We assess the structural inputs and processes of care that support HIV testing and counselling in routine antenatal care to understand supply-side dynamics critical to scaling up further integration of HIV into RMNCH services prior to recent changes in HIV policy in Tanzania.Methods: This study, as a part of a maternal and newborn health program evaluation in Morogoro Region, Tanzania, drew from an assessment of health centers with 18 facility checklists, 65 quantitative and 57 qualitative provider interviews, and 203 antenatal care observations. Descriptive analyses were performed with quantitative data using Stata 12.0, and qualitative data were analyzed thematically with data managed by Atlas.ti.Results: Limitations in structural inputs, such as infrastructure, supplies, and staffing, constrain the potential for integration of HIV testing and counselling into routine antenatal care services. While assessment of infrastructure, including waiting areas, appeared adequate, long queues and small rooms made private and confidential HIV testing and counselling difficult for individual women. Unreliable stocks of HIV test kits, essential medicines, and infection prevention equipment also had implications for provider-patient relationships, with reported decreases in women's care seeking at health centers. In addition, low staffing levels were reported to increase workloads and lower motivation for health workers. Despite adequate knowledge of counselling messages, antenatal counselling sessions were brief with incomplete messages conveyed to pregnant women. In addition, coping mechanisms, such as scheduling of clinical activities on different days, limited service availability.Conclusion: Antenatal care is a strategic entry point for the delivery of critical tests and counselling messages and the framing of patient-provider relations, which together underpin care seeking for the remaining continuum of care. Supply-side deficiencies in structural inputs and processes of delivering HIV testing and counselling during antenatal care indicate critical shortcomings in the quality of care provided. These must be addressed if integrating HIV testing and counselling into antenatal care is to result in improved maternal and newborn health outcomes.