Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
BMC Public Health. 2010 Jun 21;10:354. doi: 10.1186/1471-2458-10-354.
In 2006 the World Health Organization described the status of prevention of mother to child transmission (PMTCT) service implementation as unacceptable, with an urgent need for a renewed public health approach to improve access. For PMTCT to be effective it needs to be accessible, acceptable and affordable; however research in Africa into accessibility, uptake and acceptability of PMTCT services has been predominately urban based and usually focusing on women who deliver in hospitals. The importance of involving other community members to strengthen both PMTCT uptake and adherence, and to support women emotionally, has been advocated. Urban men's and rural traditional birth attendants' (TBAs) involvement have improved uptake of HIV testing and of nevirapine.
A qualitative study was carried out in a rural district of Malawi's central region to explore the views about and perceptions of PMTCT antiretroviral treatment. Semi-structured interviews and focus group discussions were held with antenatal and postnatal women, fathers, grandmothers, TBAs, community leaders and PMTCT health workers.
Two broad themes of findings emerged: those that relate to the hospital PMTCT service, and those that relate to the community. Trust in the hospital was strong, but distance, transport costs and perceived harsh, threatening health worker attitudes were barriers to access. Grandmothers were perceived to have influence on the management of labour, unlike fathers, but both were suggested as key people to ensure that babies are brought to the hospital for nevirapine syrup. TBAs were seen as powerful, local, and important community members, but some as uneducated.
PMTCT was seen as a community issue in which more than the mother alone can be involved. To support access to PMTCT, especially for rural women, there is need for further innovation and implementation research on involving TBAs in some aspects of PMTCT services, and in negotiating with women which community members, if any, they would like to support them in ensuring that newborn babies receive nevirapine.
2006 年，世界卫生组织（WHO）称预防母婴传播（PMTCT）服务的实施状况“无法接受”，迫切需要采取新的公共卫生措施来改善服务的可及性。PMTCT 要有效，就必须是可及的、可接受的和负担得起的；然而，非洲有关 PMTCT 服务的可及性、利用情况和接受度的研究主要是基于城市，并且通常侧重于在医院分娩的妇女。有人主张，让其他社区成员参与进来，以加强 PMTCT 的利用和坚持，并在情感上支持妇女，这一点很重要。城市男性和农村传统助产妇（TBA）的参与提高了艾滋病毒检测和奈韦拉平的利用率。
在马拉维中部地区的一个农村地区开展了一项定性研究，以探讨人们对 PMTCT 抗逆转录病毒治疗的看法和看法。对产前和产后妇女、父亲、祖母、TBA、社区领导人和 PMTCT 卫生工作者进行了半结构化访谈和焦点小组讨论。
出现了两个广泛的主题：与医院 PMTCT 服务相关的主题，以及与社区相关的主题。人们对医院的信任很强，但距离、交通费用和被认为是苛刻、威胁性的卫生工作者态度是获得服务的障碍。与父亲不同，祖母被认为对分娩管理有影响，但都被认为是确保婴儿服用奈韦拉平糖浆来医院的关键人物。TBA 被视为有影响力、本地化和重要的社区成员，但有些人认为他们没有受过教育。
PMTCT 被视为一个社区问题，不仅母亲可以参与，还可以有更多的人参与。为了支持 PMTCT 的可及性，特别是对于农村妇女，需要进一步创新和实施研究，让 TBA 参与 PMTCT 服务的某些方面，并与妇女协商，让她们选择哪些社区成员（如果有的话）支持她们，以确保新生儿服用奈韦拉平。
