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扩大 PMTCT 服务对象的避孕选择:在南非开普敦进行的一项混合方法实施研究。

Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa.

机构信息

FHI 360, 359 Blackwell Street, Durham, North Carolina 27701, USA.

出版信息

Reprod Health. 2014 Jan 10;11(1):3. doi: 10.1186/1742-4755-11-3.

Abstract

BACKGROUND

Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods.

METHODS

We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients.

RESULTS

Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects.

CONCLUSIONS

The intervention failed to improve PMTCT clients' knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally.

摘要

背景

南非预防母婴传播 (PMTCT) 服务的客户在产后使用避孕措施,主要依赖于短效方法,如避孕套、药丸和注射剂,即使他们不希望再有未来的怀孕。需要有证据表明扩大产后 PMTCT 客户的避孕选择的策略,包括长效和永久性方法。

方法

我们检查了在开普敦提供艾滋病毒阳性妇女服务的五个保健中心扩大避孕选择的过程。孕产妇/儿童保健服务提供者接受了培训和辅导,以加强产后妇女的避孕咨询,包括 PMTCT 客户。引入了培训和用品,以加强宫内节育器 (IUD) 服务,并加强了女性绝育的转诊机制。我们对分别的产后 PMTCT 客户样本(265 名干预前和 266 名干预后)进行了访谈,以评估她们对产后避孕的知识和行为。通过使用干预跟踪工具进行系统的文件记录和解释,评估了干预的实施过程。对参与研究赞助培训的提供者进行了深入访谈,以评估他们对向艾滋病毒阳性客户提供自愿避孕服务的态度和经验。

结果

干预后,6%的被访 PMTCT 客户对 IUD 有理想的知识,23%对女性绝育有理想的知识。在干预前和干预后,7%的客户接受了绝育手术,IUD 的使用微乎其微;相比之下,75%的客户使用注射剂。干预跟踪和对提供者的深入访谈揭示了干预的不足之处和卫生系统的限制,解释了未能产生预期效果的原因。

结论

干预措施未能提高 PMTCT 客户对 IUD 和绝育的知识,也未能增加这些方法的使用。为了以符合其生育愿望的方式满足产后 PMTCT 客户的计划生育需求,服务必须扩大避孕选择范围,包括长效和永久性方法。反过来,为了确保能够持续获得高质量的计划生育服务,并有效地与艾滋病毒服务相联系,还必须注重解决削弱整体卫生服务提供的基本卫生系统限制。

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