An Selena J, George Asha S, LeFevre Amnesty E, Mpembeni Rose, Mosha Idda, Mohan Diwakar, Yang Ann, Chebet Joy, Lipingu Chrisostom, Baqui Abdullah H, Killewo Japhet, Winch Peter J, Kilewo Charles
Department of International Health, International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
BMC Health Serv Res. 2015 Oct 4;15:451. doi: 10.1186/s12913-015-1111-x.
Integration of HIV into RMNCH (reproductive, maternal, newborn and child health) services is an important process addressing the disproportionate burden of HIV among mothers and children in sub-Saharan Africa. We assess the structural inputs and processes of care that support HIV testing and counselling in routine antenatal care to understand supply-side dynamics critical to scaling up further integration of HIV into RMNCH services prior to recent changes in HIV policy in Tanzania.
This study, as a part of a maternal and newborn health program evaluation in Morogoro Region, Tanzania, drew from an assessment of health centers with 18 facility checklists, 65 quantitative and 57 qualitative provider interviews, and 203 antenatal care observations. Descriptive analyses were performed with quantitative data using Stata 12.0, and qualitative data were analyzed thematically with data managed by Atlas.ti.
Limitations in structural inputs, such as infrastructure, supplies, and staffing, constrain the potential for integration of HIV testing and counselling into routine antenatal care services. While assessment of infrastructure, including waiting areas, appeared adequate, long queues and small rooms made private and confidential HIV testing and counselling difficult for individual women. Unreliable stocks of HIV test kits, essential medicines, and infection prevention equipment also had implications for provider-patient relationships, with reported decreases in women's care seeking at health centers. In addition, low staffing levels were reported to increase workloads and lower motivation for health workers. Despite adequate knowledge of counselling messages, antenatal counselling sessions were brief with incomplete messages conveyed to pregnant women. In addition, coping mechanisms, such as scheduling of clinical activities on different days, limited service availability.
Antenatal care is a strategic entry point for the delivery of critical tests and counselling messages and the framing of patient-provider relations, which together underpin care seeking for the remaining continuum of care. Supply-side deficiencies in structural inputs and processes of delivering HIV testing and counselling during antenatal care indicate critical shortcomings in the quality of care provided. These must be addressed if integrating HIV testing and counselling into antenatal care is to result in improved maternal and newborn health outcomes.
将艾滋病毒服务纳入生殖、孕产妇、新生儿和儿童健康（RMNCH）服务是应对撒哈拉以南非洲地区母亲和儿童中艾滋病毒负担过重问题的一个重要过程。我们评估了在常规产前保健中支持艾滋病毒检测和咨询的结构投入和护理过程，以了解在坦桑尼亚艾滋病毒政策近期变化之前，对进一步扩大艾滋病毒与RMNCH服务整合至关重要的供应方动态。
作为坦桑尼亚莫罗戈罗地区孕产妇和新生儿健康项目评估的一部分，本研究借鉴了对卫生中心的评估，包括18份设施清单、65次定量和57次定性的提供者访谈，以及203次产前保健观察。使用Stata 12.0对定量数据进行描述性分析，定性数据使用Atlas.ti管理的数据进行主题分析。
结构投入方面的限制，如基础设施、物资和人员配备，制约了将艾滋病毒检测和咨询纳入常规产前保健服务的潜力。虽然包括候诊区在内的基础设施评估似乎足够，但长队和小房间使个别妇女难以进行私密和保密的艾滋病毒检测和咨询。艾滋病毒检测试剂盒、基本药物和感染预防设备的库存不可靠，也对医患关系产生了影响，据报告，卫生中心寻求护理的妇女减少。此外，据报告人员配备水平低增加了工作量，降低了卫生工作者的积极性。尽管对咨询信息有足够的了解，但产前咨询会议简短，传达给孕妇的信息不完整。此外，诸如在不同日期安排临床活动等应对机制限制了服务的可及性。
产前保健是提供关键检测和咨询信息以及构建医患关系的战略切入点，这些共同支撑着对其余连续护理的寻求。产前保健期间提供艾滋病毒检测和咨询的结构投入和过程中的供应方缺陷表明所提供护理质量存在严重不足。如果要将艾滋病毒检测和咨询纳入产前保健以改善孕产妇和新生儿健康结果，就必须解决这些问题。
