Caregiver experience and perceived acceptability of a novel near point-of-care early infant HIV diagnostic test among caregivers enrolled in the PMTCT program, Myanmar: A qualitative study.
Caregiver experience and perceived acceptability of a novel near point-of-care early infant HIV diagnostic test among caregivers enrolled in the PMTCT program, Myanmar: A qualitative study.
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DOI：
10.1371/journal.pone.0241245
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
AAMI study group
中科院分区：
文献类型：
--
作者：
Yee WL;Than KK;Mohamed Y;Htay H;Tin HH;Thein W;Kyaw LL;Yee WW;Aye MM;Badman SG;Vallely AJ;Luchters S;Kelly-Hanku A;AAMI study group
儿童中大多数艾滋病毒感染是通过母婴传播发生的。建议接触艾滋病毒的婴儿在出生时或4-6周大时进行病毒学检测，但在缅甸，集中式实验室检测的挑战导致检测率低，结果沟通和治疗启动延迟。分散的保健点(POC)检测在纳入预防艾滋病毒母婴传播(PMTCT)服务时，可以作为一种替代方案，扩大婴儿早期诊断(EID)的覆盖面，并及时参与艾滋病毒治疗和护理。本文旨在探讨在缅甸参加预防母婴传播计划的艾滋病毒感染婴儿的照顾者的经历，以及与传统的集中式实验室检测相比，看护点EID检测的可接受性。这是整群随机对照阶梯楔形试验(试验注册号：ACTRN12616000734460)的子研究，该试验评估了在缅甸四家公立医院使用Xpert HIV-1 Qual化验进行的NEAR POC EID检测的影响。在主要研究的干预阶段登记的婴儿的照顾者，已经接受了XPERT和标准护理测试，并收到了符合这项定性研究的结果。对23名照顾者进行了半结构化访谈。采访被录音、逐字转录并翻译成英语。使用NVivo 12软件(QSR International)进行专题数据分析。大多数照顾者对预防母婴传播服务提供的护理质量感到满意。然而，他们在定期前往防止母婴传播诊所时遇到了社会和经济上的障碍。母亲们担心披露她们的艾滋病毒状况及其对婴儿的潜在后果会给社区带来耻辱。虽然预防母婴传播诊所的医疗服务是免费的，但照顾者有时会遇到与自付分娩和交通费用有关的经济困难。一些照顾者不得不选择不去工作(影响他们的收入)或成人抗逆转录病毒诊所，以参加儿科预防母婴传播诊所的预约。照顾者参与者对XPERT测试过程的接受度很高，超过一半的人在测试当天收到了XPERT结果。近POC开斋节检测的短期周转时间使照顾者能够更快地发现他们婴儿的艾滋病毒状况，从而缩短了紧张的等待结果的时间。我们的研究确定了暴露于艾滋病毒的婴儿的照顾者面临的重要准入挑战，以及近POC EID检测的高可接受性。提高母婴传播和EID计划的保留率需要计划经理和政策制定者认真关注这些挑战，而POC EID是一个潜在的解决方案。
The majority of HIV infection among children occurs through mother-to-child transmission. HIV exposed infants are recommended to have virological testing at birth or 4–6 weeks of age but challenges with centralized laboratory-based testing in Myanmar result in low testing rates and delays in result communication and treatment initiation. Decentralized point-of-care (POC) testing when integrated in prevention of mother-to-child transmission of HIV (PMTCT) services, can be an alternative to increase coverage of early infant diagnosis (EID) and timely engagement in HIV treatment and care. This paper aims to explore experiences of caregivers of HIV-exposed infants enrolled in the PMTCT program in Myanmar and the perceived acceptability of point-of-care EID testing compared to conventional centralised laboratory-based testing. This is a sub-study of the cluster randomised controlled stepped-wedge trial (Trial registration number: ACTRN12616000734460) that assessed the impact of near POC EID testing using Xpert HIV-1 Qual assay in four public hospitals in Myanmar. Caregivers of infants who were enrolled in the intervention phase of the main study, had been tested with both Xpert and standard of care tests and had received the results were eligible for this qualitative study. Semi-structured interviews were conducted with 23 caregivers. Interviews were audio recorded, transcribed verbatim and translated into English. Thematic data analysis was undertaken using NVivo 12 Software (QSR International). The majority of caregivers were satisfied with the quality of care provided by PMTCT services. However, they encountered social and financial access barriers to attend the PMTCT clinic regularly. Mothers had concerns about community stigma from the disclosure of their HIV status and the potential consequences for their infants. While medical care at the PMTCT clinics was free, caregivers sometimes experienced financial difficulties associated with out-of-pocket expenses for childbirth and transportation. Some caregivers had to choose not to attend work (impacting their income) or the adult antiretroviral clinic in order to attend the paediatric PMTCT clinic appointment. The acceptability of the Xpert testing process was high among the caregiver participants and more than half received the Xpert result on the same day as testing. Short turnaround time of the near POC EID testing enabled the caregivers to find out their infants’ HIV status quicker, thereby shortening the stressful waiting time for results. Our study identified important access challenges facing caregivers of HIV exposed infants and high acceptability of near POC EID testing. Improving the retention rate in the PMTCT and EID programs necessitates careful attention of program managers and policy makers to these challenges, and POC EID represents a potential solution.
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