Lubega Muhamadi, Musenze Ibrahim A, Joshua Gukiina, Dhafa George, Badaza Rose, Bakwesegha Christopher J, Reynolds Steven J
District Health Office, Iganga District Administration, Iganga, Uganda ; Research Institute, Busoga University, Iganga, Uganda ; School of Graduate Studies and Research, Busoga University, Iganga, Uganda ; National Institutes of Health/NIAID-ICER American Embassy, Kampala, Uganda.
Patient Prefer Adherence. 2013 May 22;7:447-54. doi: 10.2147/PPA.S19327. Print 2013.
In Iganga, Uganda, 45% of women who tested HIV-positive during antenatal care between 2007 and 2010 were lost to follow-up (LTFU). We explored reasons for LTFU during prevention of mother-to-child transmission (PMTCT) from a client perspective in eastern Uganda, where antiretroviral therapy (ART) awareness is presumably high.
Seven key informant interviews and 20 in-depth interviews, including both clients who had been retained under PMTCT care and those LTFU during PMTCT were held. Ten focus-group discussions involving a total of 112 participants were also conducted with caretakers/ relatives of the PMTCT clients. Content analysis was performed to identify recurrent themes.
Our findings indicate that LTFU during PMTCT in eastern Uganda was due to sex inequality, high transport costs to access the services, inadequate posttest counseling, lack of HIV status disclosure, and the isolated/exposed location of the ART clinic, which robs the clients of their privacy.
There is a need for approaches that empower women with social capital, knowledge, and skills to influence health-seeking practices. There is also a need to train low-ranking staff and take PMTCT services closer to the clients at the lower-level units to make them affordable and accessible to rural clients. Posttest counseling should be improved to enable PMTCT clients to appreciate the importance of PMTCT services through increasing the number of staff in antenatal care to match the client numbers for improved quality. The counseling should emphasize HIV status disclosure to partners and encourage partner escort for antenatal care visits for further counseling. The exposed and isolated ART clinic should be integrated with the other regular outpatient services to reduce the labeling stigma.
在乌干达伊甘加，2007年至2010年期间在产前护理中检测出艾滋病毒呈阳性的妇女中有45%失访。我们从服务对象的角度探讨了乌干达东部预防母婴传播（PMTCT）期间失访的原因，据推测该地区对抗逆转录病毒疗法（ART）的知晓率很高。
进行了7次关键信息人访谈和20次深入访谈，访谈对象包括在PMTCT护理下留存的服务对象以及在PMTCT期间失访的对象。还与PMTCT服务对象的看护人/亲属进行了10次焦点小组讨论，共有112名参与者。进行内容分析以确定反复出现的主题。
我们的研究结果表明，乌干达东部PMTCT期间失访是由于性别不平等、前往服务机构的交通成本高、检测后咨询不足、未披露艾滋病毒感染状况以及ART诊所位置偏僻/显眼，剥夺了服务对象的隐私。
需要采取方法增强妇女的社会资本、知识和技能，以影响她们寻求健康服务的行为。还需要培训基层工作人员，并将PMTCT服务延伸至较低层级单位的服务对象身边，使农村服务对象能够负担得起并方便获得这些服务。应改进检测后咨询，通过增加产前护理工作人员数量以匹配服务对象数量来提高质量，从而使PMTCT服务对象认识到PMTCT服务的重要性。咨询应强调向性伴侣披露艾滋病毒感染状况，并鼓励性伴侣陪同进行产前护理访视以便进一步咨询。位置偏僻且显眼的ART诊所应与其他常规门诊服务整合，以减少污名化。
