Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
Schools of Medicine and Pharmacy, University of Missouri - Kansas City, Kansas City, MO, USA.
AIDS Behav. 2018 Sep;22(9):2895-2905. doi: 10.1007/s10461-018-2049-x.
High rates of fertility desires, childbearing and serodiscordant partnerships among people living with HIV (PLHIV) in Uganda underscore the need to promote use of safer conception methods (SCM). Effective SCM exist but few PLHIV benefit from provider-led safer conception counseling (SCC) and comprehensive national SCC guidelines are still lacking. Providers' self-efficacy, intentions and attitudes for SCC impact provision and should inform development of services, but there are no longitudinal studies that assess these important constructs. This study reports on changes in providers' knowledge, attitudes, motivation and confidence to provide SCC among a 24-month observational cohort of Ugandan HIV providers. Compared to baseline, providers evidenced increased awareness of SCM, perceived greater value in providing SCC, saw all SCM but sperm washing as likely to be acceptable to clients, reported consistently high interest in and peer support for providing SCC, and perceived fewer barriers at the 24-month follow-up. Providers' intentions for providing SCC stayed consistently high for all SCM except manual self-insemination which decreased at 24 months. Self-efficacy for providing SCC increased from baseline with the greatest improvement in providers' confidence in advising serodiscordant couples where the man is HIV-infected. Providers consistently cite the lack of established guidelines, training, and their own reluctance to broach the issue with clients as significant barriers to providing SCC. Despite providers being more interested and open to providing SCC than ever, integration of SCC into standard HIV services has not happened. Concerted efforts are needed to address remaining barriers by establishing national SCC guidelines and implementing quality provider training.
在乌干达，艾滋病毒感染者（PLHIV）的生育率、生育愿望和血清不一致的伴侣关系都很高，这突显了需要推广使用更安全的受孕方法（SCM）。有效的 SCM 确实存在，但很少有 PLHIV 受益于提供者主导的更安全的受孕咨询（SCC），而且全面的国家 SCC 指南仍然缺乏。提供者对 SCC 的自我效能、意图和态度会影响服务的提供，并且应该为服务的发展提供信息，但目前还没有评估这些重要结构的纵向研究。本研究报告了在乌干达 HIV 提供者的 24 个月观察队列中，提供者提供 SCC 的知识、态度、动机和信心的变化。与基线相比，提供者对 SCM 的认识有所提高，认为提供 SCC 的价值更大，认为所有 SCM（但精子洗涤除外）都可能被客户接受，对提供 SCC 的兴趣和同行支持一直很高，并在 24 个月的随访中发现障碍减少。除了手动自慰，所有 SCM 的提供者提供 SCC 的意愿在 24 个月时保持不变。SCC 提供者的自我效能感从基线开始增加，在向血清不一致的夫妇（男方感染 HIV）提供咨询方面，提供者的信心有了最大的提高。提供者一直认为缺乏既定的指南、培训以及他们自己不愿意与客户讨论这个问题是提供 SCC 的重大障碍。尽管提供者对提供 SCC 的兴趣和开放程度比以往任何时候都高，但 SCC 尚未纳入标准的 HIV 服务。需要通过制定国家 SCC 指南和实施高质量的提供者培训来共同努力，以解决剩余的障碍。
