Challenges with couples, serodiscordance and HIV disclosure: healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa
Challenges with couples, serodiscordance and HIV disclosure: healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa
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DOI：
10.7448/ias.17.1.18832
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发表时间：
2014-03-12
影响因子：
6
通讯作者：
Maharaj, Pranitha
中科院分区：
文献类型：
--
作者：
Crankshaw, Tamaryn L.;Mindry, Deborah;Maharaj, Pranitha
简介： 理想情况下，更安全的受孕干预措施应该包括感染艾滋病毒的夫妇双方。对于血清不一致的夫妇，医疗保健提供者将需要管理围孕期风险行为，并根据可用资源和每个伴侣的艾滋病毒状况制定更安全的受孕策略。在广泛实施更安全的受孕服务之前，更好地了解提供者对提供护理的看法至关重要，因为它们对于成功提供更安全的受孕至关重要。本文报告了一项定性研究的结果，该研究探讨了南非德班农村和城市环境中医生、护士和非专业咨询师对更安全受孕护理的观点和经验。方法：我们在每个诊所进行了 6 次半结构化个人访谈（总共 12 次访谈），并在每个诊所进行了焦点小组讨论（总共 13 名额外参与者）。所有访谈均在 Atlas.ti 中进行编码，使用扎根理论方法来开发代码并识别数据中的核心主题和副主题。结果：管理与希望怀孕的血清不一致夫妇相关的临床和关系复杂性被所有类别的医疗服务提供者标记为关注点。提供者补充说，在艾滋病毒临床环境中，他们经常发现很难平衡自己的专业优先事项、维护客户的健康并确保伴侣不会面临不必要的风险，同时仍然支持客户生孩子的愿望。许多提供者对与伴侣之间披露艾滋病毒状况有关的问题表示担忧，特别是在管理一方不知道另一方的状况并表达了想要孩子的愿望的夫妇时。提供者的经验是，女性客户最常寻求护理，很难联系到男性伴侣让他参与咨询。结论：提供者需要支持来处理艾滋病毒披露问题，并在处理夫妻和血清不一致问题时变得更有信心。在实施更安全的受孕计划之前，需要对医疗保健专业人员进行集中培训，以解决在更安全的受孕护理背景下至关重要的一些道德和关系问题。
Introduction: Safer conception interventions should ideally involve both members of an HIV-affected couple. With serodiscordant couples, healthcare providers will need to manage periconception risk behaviour as well tailor safer conception strategies according to available resources and the HIV status of each partner. Prior to widespread implementation of safer conception services, it is crucial to better understand provider perspectives regarding provision of care since they will be pivotal to the successful delivery of safer conception. This paper reports on findings from a qualitative study exploring the viewpoints and experiences of doctors, nurses, and lay counsellors on safer conception care in a rural and in an urban setting in Durban, South Africa.Methods: We conducted six semistructured individual interviews per site (a total of 12 interviews) as well as a focus group discussion at each clinic site (a total of 13 additional participants). All interviews were coded in Atlas.ti using a grounded theory approach to develop codes and to identify core themes and subthemes in the data.Results: Managing the clinical and relationship complexities related to serodiscordant couples wishing to conceive was flagged as a concern by all categories of health providers. Providers added that, in the HIV clinical setting, they often found it difficult to balance their professional priorities, to maintain the health of their clients, and to ensure that partners were not exposed to unnecessary risk, while still supporting their clients' desires to have a child. Many providers expressed concern over issues related to disclosure of HIV status between partners, particularly when managing couples where one partner was not aware of the other's status and expressed the desire for a child. Provider experiences were that female clients most often sought out care, and it was difficult to reach the male partner to include him in the consultation.Conclusions: Providers require support in dealing with HIV disclosure issues and in becoming more confident in dealing with couples and serodiscordance. Prior to implementing safer conception programmes, focused training is needed for healthcare professionals to address some of the ethical and relationship issues that are critical in the context of safer conception care.