Mashamba-Thompson T P, Drain P K, Sartorius B
Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Department of Global Health, International Clincial Research Center, University of Washington, Seattle, Washington, USA Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, USA Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
BMJ Open. 2016 Jun 27;6(6):e011155. doi: 10.1136/bmjopen-2016-011155.
Poor healthcare access is a major barrier to receiving antenatal care and a cause of high maternal mortality in South Africa (SA). 'Point-of-care' (POC) diagnostics is a powerful emerging healthcare approach to improve healthcare access. This study focuses on evaluating the accessibility and utility of POC diagnostics for maternal health in rural SA primary healthcare (PHC) clinics in order to generate a model framework of implementation of POC diagnostics in rural South African clinics.
We will use several research methods, including a systematic review, quasi-experiments, survey, key informant interviews and audits. We will conduct a systematic review and experimental study to determine the impact of POC diagnostics on maternal health. We will perform a cross-sectional case study of 100 randomly selected rural primary healthcare clinics in KwaZulu-Natal to measure the context and patterns of POC diagnostics access and usage by maternal health providers and patients. We will conduct interviews with relevant key stakeholders to determine the reasons for POC deficiencies regarding accessibility and utility of HIV-related POC diagnostics for maternal health. We will also conduct a vertical audit to investigate all the quality aspects of POC diagnostic services including diagnostic accuracy in a select number of clinics. On the basis of information gathered, we will propose a model framework for improved implementation of POC diagnostics in rural South African public healthcare clinics. Statistical (Stata-13) and thematic (NVIVO) data analysis will be used in this study.
The study protocol was approved by the Ethics Committee of the University of KwaZulu-Natal (BE 484/14) and the KwaZulu-Natal Department of Health based on the Helsinki Declaration (HRKM 40/15). Findings of this study will be disseminated electronically and in print. They will be presented to conferences related to HIV/AIDS, diagnostics, maternal health and strengthening of health systems.
在南非，医疗服务可及性差是获得产前护理的主要障碍，也是孕产妇死亡率高的一个原因。“即时检验”（POC）诊断是一种新兴的、强有力的医疗保健方法，可改善医疗服务的可及性。本研究聚焦于评估POC诊断在南非农村初级卫生保健（PHC）诊所用于孕产妇保健的可及性和实用性，以便生成在南非农村诊所实施POC诊断的模式框架。
我们将使用多种研究方法，包括系统评价、准实验、调查、关键信息人访谈和审计。我们将开展一项系统评价和实验研究，以确定POC诊断对孕产妇健康的影响。我们将对夸祖鲁-纳塔尔省随机选取的100家农村初级卫生保健诊所进行横断面案例研究，以衡量孕产妇保健提供者和患者获取和使用POC诊断的背景及模式。我们将与相关关键利益攸关方进行访谈，以确定在孕产妇保健方面，与HIV相关的POC诊断在可及性和实用性方面存在不足的原因。我们还将进行纵向审计，以调查POC诊断服务的所有质量方面，包括在部分诊所的诊断准确性。基于收集到的信息，我们将提出一个在南非农村公共医疗诊所更好地实施POC诊断的模式框架。本研究将使用统计（Stata-13）和主题（NVIVO）数据分析。
本研究方案已获得夸祖鲁-纳塔尔大学伦理委员会（BE 484/14）以及基于《赫尔辛基宣言》的夸祖鲁-纳塔尔省卫生部（HRKM 40/15）的批准。本研究的结果将以电子和印刷形式传播。这些结果将在与艾滋病毒/艾滋病、诊断、孕产妇健康及卫生系统强化相关的会议上展示。
