Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study
Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study
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DOI：
10.1371/journal.pone.0225642
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发表时间：
2019-11-22
期刊：
影响因子：
3.7
通讯作者：
Finocchario-Kessler, Sarah
中科院分区：
文献类型：
--
作者：
Wexler, Catherine;Maloba, May;Finocchario-Kessler, Sarah
出生时和护理点（POC）HIV检测是简化婴儿HIV诊断和加速HIV阳性婴儿ART启动的新兴策略。本定性研究的目的是评估影响因素的提供和接受出生时的POC检测之间的艾滋病毒护理提供者和父母的艾滋病毒暴露的婴儿在Keny.MethodsWe进行了半结构化的采访，26艾滋病毒护理提供者和35父母的艾滋病毒暴露的婴儿（包括23名母亲，6名父亲，和3母亲，父亲对）在四个研究医院之前，POC实施。在每次访谈之前，向参与者提供了与POC相关的最佳现有证据的概述。访谈探讨了标准的EID服务，感知的好处和风险的出生和POC测试，并建议后勤提供出生和POC。对访谈进行了录音、翻译（如有必要）和逐字记录。使用跨学科的循证实践模型来指导分析，成绩单编码的基础上先验的主题相关的环境背景下，病人的特点，和resources.ResultsMost供应商（24/26）和家长（30/35）举行了有利的态度，在出生时POC测试。早期结果改善婴儿护理和减少父母焦虑的潜力推动了出生时POC检测的偏好。对出生时POC检测持不利看法的父母更喜欢在6周时进行标准检测，这样母亲可以在出生后痊愈，并有时间在可能得知他们的孩子是HIV阳性之前与新生儿建立联系。Providers identified the lack of resources（shortage of staff，expertise，and space）as a barrier.DiscussionWhile overall acceptability of at birth POC testing among HIV care providers and parents of HIV exposed infants may facilitate uptake，barriers remain.采用任务转移的方法来实施，并确保提供者接受出生时POC测试的培训，可以减轻与提供者相关的挑战。在产前和产后期间进行全面的咨询可以减轻患者相关的挑战。
BackgroundAt-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya.MethodsWe conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIVexposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources.ResultsMost providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before-possibly-learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier.DiscussionWhile overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges.