Strategies to improve male involvement in PMTCT Option B plus in four African countries: a qualitative rapid appraisal
Strategies to improve male involvement in PMTCT Option B plus in four African countries: a qualitative rapid appraisal
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DOI：
10.3402/gha.v9.33507
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发表时间：
2016-01-01
影响因子：
2.6
通讯作者：
Doherty, Tanya
中科院分区：
文献类型：
--
作者：
Besada, Donela;Rohde, Sarah;Doherty, Tanya
背景：世界卫生组织建议，无论艾滋病毒感染处于哪个阶段，都应尽快开始抗逆转录病毒治疗。这种“测试治疗”方法强调了确保男性参与预防母婴艾滋病毒传播（PMTCT）的必要性。本文介绍了在乌干达、刚果民主共和国、马拉维和科特迪瓦扩大B+方案的背景下，对提高男性伴侣参与预防母婴传播服务的战略进行快速评估的结果。设计：在对四个国家进行实地访问期间，通过焦点小组和个人访谈进行定性快速评估来收集数据。在首都与卫生部工作人员和执行伙伴进行了访谈，在地区一级与每个国家的地区管理小组、设施卫生工作者和社区卫生干部进行了访谈。结果：各国采取了共同战略，推动社会变革，促使男子更多地参与孕产妇、儿童和妇女保健以及预防母婴传播服务。基于社区的战略包括通过对话和社会动员让社区领导人参与，让社区保健工作者参与，并建立和加强男性同侪干部队伍。以设施为基础的策略包括提供激励措施，如缩短等待时间，通过改变诊所时间为男性提供便利，以及建立家庭支持小组。结论：在社区和设施层面实施的方法是根据当地情况量身定制的，考虑到文化规范和地理区域差异。虽然这些战略背后的意图旨在对家庭产生积极影响，但确实发生了意想不到的消极后果，需要解决这些问题并调整战略。对“男性参与”预防母婴传播服务的一致定义和指标框架将有助于捕捉战略对文化和行为转变的影响。关于男性参与的国家政策将有助于简化各项目的做法，确保大规模实施，从而显著改善家庭健康结果。
Background: The World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This 'testand treat' approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Cote d'Ivoire in the context of scale-up of Option B+ protocol.Design: Data were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs) and at district level with district management teams, facility-based health workers and community health cadres in each country.Results: Common strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women's health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups.Conclusions: The approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted.A consistent definition of 'male involvement' in PMTCT services and a framework of indicators would be helpful to capture the impact of strategies on cultural and behavioral shifts. National policies around male involvement would be beneficial to streamline approaches across IPs and ensure wide-scale implementation, to achieve significant improvements in family health outcomes.