Fundation for Professional Development, 10 Rochester Road, East London, 5217, South Africa.
The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
BMC Public Health. 2020 Apr 28;20(1):577. doi: 10.1186/s12889-020-08689-3.
Sexually transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. Yet the World Health Organization's current syndromic management guidelines for STIs leaves most pregnant women undiagnosed and untreated. Point-of-care (POC) diagnostic tests for STIs can drastically improve detection and treatment. Though acceptable and feasible, poor medication adherence and re-infection due to lack of partner treatment threaten the programmatic effectiveness of POC diagnostic programmes.
To engender patient-provider trust, and improve medication adherence and disclosure of STI status to sexual partners, we trained study nurses in compassionate care, good clinical practices and motivational interviewing. Using qualitative methods, we explored the role patient-provider communications may play in supporting treatment adherence and STI disclosure to sexual partners. Nurses were provided training in motivational interviewing, compassionate care and good clinical practices. Participants were interviewed using a semi-structured protocol, with domains including STI testing experience, patient-provider communication, and HIV and STI disclosure. Interviews were audio-recorded, transcribed and analyzed using a constant comparison approach.
Twenty-eight participants treated for Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and/or Neisseria gonorrhea (NG) were interviewed. Participants described strong communications and trusting relationships with nurses trained in patient-centered care training and implementing POC STI diagnostic testing. However, women described a delayed trust in treatment until their symptoms resolved. Women expressed a limited recall of their exact diagnosis, which impacted their ability to fully disclose their STI status to sexual partners.
We recommend implementing patient health literacy programmes as part of POC services to support women in remembering and disclosing their specific STI diagnosis to sexual partners, which may facilitate partner treatment uptake and thus decrease the risk of re-infection.
妊娠期间的性传播感染（STIs）会导致新生儿发病率和死亡率增加，并可能增加母婴 HIV 传播的风险。然而，世界卫生组织目前的 STIs 综合征管理指南使得大多数孕妇未得到诊断和治疗。即时检测（POC）STI 诊断测试可以极大地提高检测和治疗效果。虽然可接受且可行，但由于缺乏伴侣治疗而导致的药物依从性差和再次感染威胁着 POC 诊断计划的方案有效性。
为了建立医患信任，并提高药物依从性和向性伴侣披露 STI 状况，我们对研究护士进行了共情关怀、良好临床实践和动机性访谈方面的培训。我们使用定性方法探讨了医患沟通在支持治疗依从性和向性伴侣披露 STI 状况方面可能发挥的作用。护士接受了动机性访谈、共情关怀和良好临床实践方面的培训。使用半结构化方案对参与者进行访谈，访谈内容包括 STI 检测经验、医患沟通以及 HIV 和 STI 披露等方面。访谈进行了录音、转录，并使用恒定比较方法进行了分析。
对 28 名接受过衣原体（CT）、阴道毛滴虫（TV）和/或淋病奈瑟菌（NG）治疗的参与者进行了访谈。参与者描述了与接受以患者为中心的关怀培训和实施 POC STI 诊断检测的护士之间的紧密沟通和信任关系。然而，女性描述说，直到症状缓解后才开始对治疗产生信任。女性表示对自己的确切诊断记忆有限，这影响了她们向性伴侣充分披露 STI 状况的能力。
我们建议在 POC 服务中实施患者健康素养计划，以支持女性记住和向性伴侣披露其具体的 STI 诊断，这可能有助于伴侣接受治疗，从而降低再次感染的风险。
