乌干达卫生工作者在为 HIV 阳性儿童提供咨询服务方面面临的挑战：一项描述性研究。
Challenges faced by health workers in providing counselling services to HIV-positive children in Uganda: a descriptive study.
机构信息
Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.
出版信息
J Int AIDS Soc. 2010 Mar 7;13:9. doi: 10.1186/1758-2652-13-9.
BACKGROUND
The delivery of HIV counselling and testing services for children remains an uphill task for many health workers in HIV-endemic countries, including Uganda. We conducted a descriptive study to explore the challenges of providing HIV counselling and testing services to children in Uganda.
METHODS
A descriptive study was conducted in the districts of Kampala and Kabarole in Uganda. The data were collected using semi-structured individual interviews and focus group discussions with health workers who are involved in the care of HIV-positive children. Key informant interviews were conducted with the administrators of the 10 study healthcare institutions. Quantitative data were summarized using frequency tables, while qualitative data were analyzed using the content thematic approach.
RESULTS
Counselling children was reported to be a difficult exercise due to some children being unable to express themselves, being dependent on adults for their care, being fearful, and requiring more time to open up during counselling. This was compounded by some caretakers' unwillingness and difficulty to disclose the HIV status of their children. Other issues about the caretakers were: lack of consistency in caretakers; old age; sickness; and poverty. Health workers mentioned the following as some of the challenges they face in the delivery of HIV counselling and testing services for children: lack of counselling skills; failure to cope with the knowledge demand; difficulty to facilitate disclosure; heavy work load; and lack of other support services. Institutions were found to be constrained by limited space and lack of antiretrovirals for children.
CONCLUSIONS
The major challenges in the delivery of paediatric HIV services were related to the knowledge gap in paediatric HIV and the lack of counselling skills, as well as health system-related constraints. There is a need to train health workers in child-counselling skills, especially in the issues of disclosure, sexuality and sexual abuse, as well as in addressing fears related to death and an uncertain future, in order to improve paediatric HIV care. Provision of child-friendly services, guidelines and antiretroviral formulations for children may provide a window of hope to improve HIV counselling and testing services for children.
背景
在艾滋病毒流行的国家，包括乌干达在内，许多卫生工作者为儿童提供艾滋病毒咨询和检测服务仍然是一项艰巨的任务。我们进行了一项描述性研究，以探讨在乌干达为儿童提供艾滋病毒咨询和检测服务所面临的挑战。
方法
在乌干达坎帕拉和卡巴罗莱地区进行了一项描述性研究。数据收集使用半结构式个人访谈和焦点小组讨论，参与者是参与照顾艾滋病毒阳性儿童的卫生工作者。对 10 家研究医疗机构的管理人员进行了重点人物访谈。定量数据采用频数表进行总结，定性数据采用内容主题分析方法进行分析。
结果
由于一些儿童无法表达自己，依赖成年人照顾，害怕并需要更多时间在咨询中敞开心扉，为儿童提供咨询被报告为一项困难的工作。此外，一些照顾者不愿意和难以透露其子女的艾滋病毒状况。关于照顾者的其他问题是：照顾者缺乏一致性；年龄大；患病；和贫穷。卫生工作者提到他们在为儿童提供艾滋病毒咨询和检测服务方面面临的一些挑战包括：缺乏咨询技能；无法应对知识需求；难以促进披露；工作量大；缺乏其他支持服务。机构受到空间有限和缺乏儿童抗逆转录病毒药物的限制。
结论
提供儿科艾滋病毒服务的主要挑战与儿科艾滋病毒知识差距以及缺乏咨询技能以及卫生系统相关限制有关。需要培训卫生工作者儿童咨询技能，特别是在披露、性和性虐待以及解决与死亡和不确定未来相关的恐惧等问题方面，以改善儿科艾滋病毒护理。提供适合儿童的服务、指南和儿童抗逆转录病毒制剂可能为改善儿童艾滋病毒咨询和检测服务提供希望之窗。
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