Chiya Hlolisile W, Naidoo Joanne R, Ncama Busisiwe P
School of Nursing and Public Health, University of KwaZulu-Natal.
Afr J Prim Health Care Fam Med. 2018 Nov 15;10(1):e1-e10. doi: 10.4102/phcfm.v10i1.1788.
South Africa's prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) programme has undergone rapid changes in the last two decades. Initially, the provision of single antiretroviral therapy was based on eligibility criteria in the year 2001, which later changed to combination therapy. This was aimed at preventing mother-to-child transmission of HIV. Since 2015, all pregnant women were eligible for antiretroviral treatment regardless of their CD4 count. Although significant strides were made to reduce mother-to-child transmission of HIV, increased efforts are required to meet UNAIDS targets, World Health Organization (WHO) elimination framework goals and sustainable development goals to eliminate new HIV infections in children and ending the HIV epidemic by 2030.
The aim of the study was to explore healthcare workers' experiences and patient perceptions of the implementation of rapid changes to the PMTCT programme in four public healthcare facilities.
The study was conducted in the four public healthcare facilities within the two highly HIV-burdened districts of iLembe and eThekwini in KwaZulu-Natal province, South Africa.
This study used a qualitative, exploratory, descriptive study design using interviews and focus group discussions. Participants were selected using purposive sampling. Following verbatim transcription of the data, thematic data analysis was used through data reduction and data display and the emergence of four themes.
A total of 61 stakeholders were interviewed. Four major themes emerged: (1) impact of poor health system design, (2) impact of poor communication of changes, (3) contextual factors affecting innovation in healthcare and (4) skill deficit in change management and forward planning.
A healthcare system more responsive to the experiences of healthcare workers and pregnant women is required to effectively implement changes in priority programmes.
在过去二十年里，南非预防人类免疫缺陷病毒（HIV）母婴传播（PMTCT）项目经历了快速变革。最初，2001年提供单一抗逆转录病毒疗法是基于资格标准，后来改为联合疗法。这旨在预防HIV母婴传播。自2015年以来，所有孕妇无论其CD4细胞计数如何，都有资格接受抗逆转录病毒治疗。尽管在减少HIV母婴传播方面取得了重大进展，但仍需加大努力，以实现联合国艾滋病规划署（UNAIDS）的目标、世界卫生组织（WHO）的消除框架目标以及可持续发展目标，即在2030年前消除儿童中的新发HIV感染并终结HIV流行。
本研究的目的是探讨医护人员在四个公共医疗机构实施PMTCT项目快速变革中的经历以及患者的看法。
该研究在南非夸祖鲁-纳塔尔省伊莱姆贝和德班这两个HIV负担沉重地区的四个公共医疗机构进行。
本研究采用定性、探索性、描述性研究设计，使用访谈和焦点小组讨论。采用目的抽样法选择参与者。对数据进行逐字转录后，通过数据简化、数据展示以及四个主题的出现，进行了主题数据分析。
共采访了61名利益相关者。出现了四个主要主题：（1）卫生系统设计不佳的影响，（2）变革沟通不畅的影响，（3）影响医疗保健创新的背景因素，（4）变革管理和前瞻性规划方面的技能不足。
需要一个对医护人员和孕妇的经历更具响应性的医疗系统，以有效实施重点项目的变革。
