West Nora, Schwartz Sheree, Phofa Rebecca, Yende Nompumelelo, Bassett Jean, Sanne Ian, Van Rie Annelies
a Witkoppen Health and Welfare Centre , Johannesburg , South Africa.
b Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
AIDS Care. 2016;28(3):390-6. doi: 10.1080/09540121.2015.1093596. Epub 2015 Oct 7.
The 2011 guidelines for safer conception for HIV-affected individuals and couples were adopted by the South African Department of Health in December 2012. We assessed implementation gaps and facilitators and barriers to delivering safer conception services through examining patient and healthcare provider (HCP) experiences. At Witkoppen Health and Welfare Centre, a primary care clinic in Johannesburg, we conducted in-depth interviews (IDIs) with nine HCPs (doctors, nurses, and counselors) and IDIs and focus group discussions with 42 HIV-affected men and women interested in having a child. Data were analyzed using a grounded theory approach. HCPs were supportive of fertility intentions of HIV-affected couples and demonstrated some knowledge of safer conception methods, especially ART initiation to suppress viral load in infected partners. Unfortunately, HCPs did not follow the key recommendation that HCPs initiate conversations on fertility intentions with HIV-affected men and women. Providers and clients reported that conversations about conception only occur when client-initiated, placing the onus on HIV-affected individuals. Important barriers underlying this were the misconception held by some HCPs that uninfected partners in serodiscordant partnerships are "latently" infected and the desire by most HCPs to protect or control knowledge around fertility and safer conception methods out of concern over what clients will do with this knowledge before they are virally suppressed or ready to conceive. Almost all participants who had conceived or attempted conception did so without safer conception methods knowledge. HCP concern over conception readiness, perception of what clients will do with safer conception knowledge, and gaps in safer conception knowledge prevent HCPs from initiating conversations with HIV-affected patients on the issue of childbearing. Examining these findings in the context of existing South African guidelines illuminates areas that need to be addressed to facilitate implementation of the guidelines.
2011年《受艾滋病毒影响的个人和夫妇更安全受孕指南》于2012年12月被南非卫生部采用。我们通过考察患者及医疗服务提供者（HCP）的经历，评估了更安全受孕服务在实施过程中的差距、促进因素及障碍。在约翰内斯堡的一家初级保健诊所维特科普恩健康与福利中心，我们对9名医疗服务提供者（医生、护士和咨询师）进行了深入访谈（IDI），并对42名有生育意愿的受艾滋病毒影响的男性和女性进行了深入访谈及焦点小组讨论。采用扎根理论方法对数据进行分析。医疗服务提供者支持受艾滋病毒影响夫妇的生育意愿，并展示了一些更安全受孕方法的知识，尤其是通过启动抗逆转录病毒治疗（ART）来抑制感染伴侣的病毒载量。不幸的是，医疗服务提供者未遵循关键建议，即与受艾滋病毒影响的男性和女性就生育意愿展开对话。提供者和客户报告称，关于受孕的对话仅在客户主动发起时才会发生，这将责任推给了受艾滋病毒影响的个人。造成这种情况的重要障碍包括一些医疗服务提供者存在误解，认为血清学不一致伴侣关系中未感染的一方“潜在”感染，以及大多数医疗服务提供者出于对客户在病毒得到抑制或准备受孕之前如何利用这些知识的担忧，希望保护或控制有关生育和更安全受孕方法的知识。几乎所有已受孕或尝试受孕的参与者都是在不了解更安全受孕方法的情况下进行的。医疗服务提供者对受孕准备情况的担忧、对客户如何利用更安全受孕知识的看法以及更安全受孕知识方面的差距，阻碍了医疗服务提供者与受艾滋病毒影响的患者就生育问题展开对话。结合南非现有指南审视这些研究结果，可明确为促进指南实施而需解决的领域。
