Division of Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Nobelsv 9, 171 77, Stockholm, Sweden.
Health Policy Plan. 2012 Jan;27(1):69-75. doi: 10.1093/heapol/czr009. Epub 2011 Feb 3.
Two years after the introduction of provider-initiated, opt-out HIV counselling and testing during antenatal care (ANC) in Uganda, HIV testing uptake is still low. This study was carried out to explore pregnant women's experiences of, and views on, the policies for opt-out, and couple HIV testing, and to understand how the policy implementation could be improved in order to increase access to prevention of mother-to-child-transmission (PMTCT) services. The study was conducted at three ANC health facilities at different levels of care in rural eastern Uganda. Data were collected through sit-in observations during ANC and 18 semi-structured interviews with pregnant women receiving ANC, and thereafter analysed using latent content analysis. Pregnant women who received ANC from facilities that provided HIV testing on-site perceived HIV testing as compulsory without actually fully realizing the benefits of HIV testing and PMTCT. No referral for HIV testing or information about testing was given at ANC facilities that lacked HIV testing on-site. A major challenge of couple HIV testing was that pregnant women were made responsible for recruiting their spouses for testing, a precarious dilemma for many women who tried to fulfil health workers' requests without having the power to do so. In order to increase uptake of PMTCT services, the pre-test counselling in groups that precedes the provider-initiated HIV testing should be adjusted to inform women about the benefits of PMTCT. Further, if testing is perceived as compulsory it could potentially deter some women from seeking ANC services. In order to increase HIV testing of male partners new strategies are needed, for example peer-sensitization and male clinics. Moreover, to achieve the desired outcomes of the PMTCT programme, monitoring and evaluation should be built into the programme.
在乌干达引入医护人员主导的、默认选择的 HIV 咨询和检测进行产前护理（ANC）两年后，HIV 检测的采用率仍然很低。本研究旨在探索孕妇对默认选择和夫妇 HIV 检测政策的经验和看法，并了解如何改进政策实施，以增加预防母婴传播（PMTCT）服务的获取。该研究在乌干达农村东部三个不同护理水平的 ANC 卫生机构进行。数据通过 ANC 期间的现场观察和 18 名接受 ANC 的孕妇的半结构化访谈收集，然后使用潜在内容分析进行分析。在提供现场 HIV 检测的 ANC 设施接受 ANC 的孕妇认为 HIV 检测是强制性的，而实际上并没有充分意识到 HIV 检测和 PMTCT 的好处。在缺乏现场 HIV 检测的 ANC 设施，没有提供 HIV 检测转诊或检测信息。夫妇 HIV 检测的主要挑战是，孕妇负责招募配偶进行检测，对于许多试图满足卫生工作者的要求而又没有能力这样做的女性来说，这是一个不稳定的困境。为了增加 PMTCT 服务的采用率，应该调整群体预测试咨询，在医护人员主导的 HIV 检测之前，告知妇女 PMTCT 的好处。此外，如果检测被视为强制性的，可能会阻止一些妇女寻求 ANC 服务。为了增加男性伴侣的 HIV 检测，需要新的策略，例如同伴宣传和男性诊所。此外，为了实现 PMTCT 计划的预期结果，应该将监测和评估纳入计划。
