Program synergies and social relations: implications of integrating HIV testing and counselling into maternal health care on care seeking
Program synergies and social relations: implications of integrating HIV testing and counselling into maternal health care on care seeking
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DOI：
10.1186/s12889-014-1336-3
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发表时间：
2015-01-21
影响因子：
4.5
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：撒哈拉以南非洲的妇女和儿童承受着不成比例的艾滋病毒/艾滋病负担。将艾滋病毒防治工作与妇幼服务结合起来，目的是减少艾滋病毒/艾滋病的影响。为了评估这种整合的潜在收益和风险，本文考虑了坦桑尼亚孕妇和提供者对综合艾滋病毒检测和咨询对孕妇产前护理期间寻求护理的影响的看法。方法：根据对坦桑尼亚莫罗戈罗综合孕产妇和新生儿保健计划的更大评估，这项分析包括来自203次产前护理观察的信息子集，以及对来自农村和城市周边地区18个公共卫生中心的57名提供者和190名孕妇的访谈。定性数据进行了手动分析，并与阿特拉斯。结果：妇女和医务人员对HIV检测与常规产前检查相结合的认识总体上是积极的。受访者认为，一体化增加了艾滋病毒检测的覆盖面，特别是在难以接触的人群中，并提高了便利性，效率和保密性，同时减少了耻辱感。孕妇认为，及早发现艾滋病毒可以保护自己及其子女的健康。尽管有这些积极的看法，但挑战依然存在。提供者和妇女认为，在产前服务期间，艾滋病毒检测和咨询是强制性的。一些妇女的答复中弥漫着一种无能为力和焦虑的感觉，反映了妇女与提供者之间的不平等关系、缺乏支持性沟通以及违反保密规定。最后，耻辱围绕艾滋病毒的报道，导致一些妇女停止服务或寻求保健通过其他接入点在health system.Conclusion：虽然供应商和孕妇认为从整合艾滋病毒服务到产前保健积极的方案协同作用，缺乏支持性的提供者与患者的关系，缺乏信任，造成严厉的治疗或违反保密，和耻辱仍然抑制妇女的护理寻求。随着各国继续推出备选方案B+，必须了解和处理患者与提供者之间的社会关系，以确保艾滋病毒咨询和服务的综合提供鼓励妇女寻求护理，从而改善孕产妇和儿童健康。
Background: Women and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. Integration of HIV with maternal and child services aims to reduce the impact of HIV/AIDS. To assess the potential gains and risks of such integration, this paper considers pregnant women's and providers' perceptions about the effects of integrated HIV testing and counselling on care seeking by pregnant women during antenatal care in Tanzania.Methods: From a larger evaluation of an integrated maternal and newborn health care program in Morogoro, Tanzania, this analysis included a subset of information from 203 observations of antenatal care and interviews with 57 providers and 190 pregnant women from 18 public health centers in rural and peri-urban settings. Qualitative data were analyzed manually and with Atlas. ti using a framework approach, and quantitative data of respondents' demographic information were analyzed with Stata 12.0.Results: Perceptions of integrating HIV testing with routine antenatal care from women and health providers were generally positive. Respondents felt that integration increased coverage of HIV testing, particularly among difficult-toreach populations, and improved convenience, efficiency, and confidentiality for women while reducing stigma. Pregnant women believed that early detection of HIV protected their own health and that of their children. Despite these positive views, challenges remained. Providers and women perceived opt out HIV testing and counselling during antenatal services to be compulsory. A sense of powerlessness and anxiety pervaded some women's responses, reflecting the unequal relations, lack of supportive communications and breaches in confidentiality between women and providers. Lastly, stigma surrounding HIV was reported to lead some women to discontinue services or seek care through other access points in the health system.Conclusion: While providers and pregnant women view program synergies from integrating HIV services into antenatal care positively, lack of supportive provider-patient relationships, lack of trust resulting from harsh treatment or breaches in confidentiality, and stigma still inhibit women's care seeking. As countries continue rollout of Option B+, social relations between patients and providers must be understood and addressed to ensure that integrated delivery of HIV counselling and services encourages women's care seeking in order to improve maternal and child health.