Haruna Tausi S, Assenga Evelyne, Shayo Judith
Hubert Kairuki Memorial University, P.O.Box 65300, Dar es Salaam, Tanzania.
Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es salaam, Tanzania.
BMC Med Ethics. 2018 Nov 21;19(1):92. doi: 10.1186/s12910-018-0329-7.
Mother-to-child transmission (MTCT) of the Human Immunodeficiency -Virus (HIV) is a serious public health problem, contributing up to 90% of childhood HIV infections. In Tanzania, the prevention-of-mother-to-child-transmission (PMTCT) feature of the HIV programme was rolled out in 2000. The components of PMTCT include counselling and HIV testing directed at antenatal clinic attendees. It is through the process of Provider Initiated Counseling and Testing (PITC) that counselling is offered participant confidentiality and voluntariness are upheld and valid consent obtained. The objective of the study was to explore antenatal clinic attendees' experiences of the concept of voluntariness vis- a- vis the implementation of prior counseling and subsequent testing for HIV under the PITC as part of their antenatal care.
In-depth interviews were conducted with17 antenatal clinic attendees and 6 nursing officers working at the Muhimbili National Hospital (MNH) antenatal clinic. The study data were analyzed using qualitative content analysis.
Antenatal clinic attendees' accounts suggested that counselling and testing for HIV during pregnancy was voluntary, and that knowledge of their HIV status led them to access appropriate treatment for both mother and her newborn baby. They reported feeling no pressure from nursing officers, and gave verbal consent to undergo the HIV test. However, some antenatal clinic attendees reported pressure from their partners to test for HIV. Healthcare providers were thus faced with a dilemma of disclosure/ nondisclosure when dealing with discordant couples.
Antenatal clinic attendees at MNH undertook the PITC for HIV voluntarily. This was enhanced by their prior knowledge of HIV, the need to prevent mother- to- child transmission of HIV, and the effectiveness of the voluntary policy implemented by nursing officers.
人类免疫缺陷病毒（HIV）的母婴传播（MTCT）是一个严重的公共卫生问题，占儿童HIV感染病例的90%。在坦桑尼亚，HIV项目的预防母婴传播（PMTCT）特色措施于2000年推出。PMTCT的组成部分包括针对产前门诊就诊者的咨询和HIV检测。正是通过提供者发起的咨询和检测（PITC）过程，咨询服务得以提供，参与者的保密性和自愿性得到维护，并获得有效同意。本研究的目的是探讨产前门诊就诊者对于在PITC模式下作为产前护理一部分进行HIV咨询及后续检测时自愿性概念的体验。
对17名产前门诊就诊者以及在穆希姆比利国家医院（MNH）产前门诊工作的6名护理人员进行了深入访谈。研究数据采用定性内容分析法进行分析。
产前门诊就诊者的叙述表明，孕期进行HIV咨询和检测是自愿的，并且了解自身HIV感染状况促使她们为自己和新生儿寻求适当治疗。她们表示没有感受到护理人员的压力，并口头同意接受HIV检测。然而，一些产前门诊就诊者称其伴侣施加了进行HIV检测的压力。因此，医疗服务提供者在处理夫妻双方HIV检测结果不一致的情况时面临着是否披露信息的两难困境。
MNH的产前门诊就诊者自愿接受了HIV的PITC检测。她们对HIV的预先了解、预防HIV母婴传播的需求以及护理人员实施的自愿政策的有效性增强了这种自愿性。
