King Rachel, Matovu Joyce Namale, Rujumba Joseph, Wavamunno Priscilla, Amone Alexander, Gabagaya Grace, Fowler Mary Glenn, Homsy Jaco, Seeley Janet, Musoke Philippa
Institute for Global Health Sciences, University of California, San Francisco, USA.
Makerere University/Johns Hopkins University Research Collaboration, Kampala, Uganda.
Afr J AIDS Res. 2020 Jul;19(2):135-146. doi: 10.2989/16085906.2020.1760325.
Since 2012, PMTCT Option B+ has been recommended by the World Health Organization to reduce vertical transmission but numerous adherence challenges remain. We conducted a qualitative study at baseline using six focus group discussions and 14 in-depth interviews to explore knowledge, beliefs, attitudes and challenges towards the Option B+ strategy for PMTCT among HIV-infected pregnant and post-partum women and health workers engaged in Uganda's national Option B+ PMTCT programme. Data were analysed using a thematic approach to capture latent and manifest content with the social ecological model as a theoretic foundation in order to make contextual sense of key stakeholders' needs for an effective Option B+ intervention. Overall, among all study participants, we found multi-level barriers to adhering to Option B+ cutting across all levels of the social ecological model. In line with the model, our study revealed barriers at personal, relational, organizational and societal levels. Some personal beliefs such as that the baby's health is more important that the mother's, organizational (negative attitudes and behaviour of health workers), structural such as poverty, work conflicts, fear and lack of disclosure related to community stigma were all critical obstacles to women adhering to the Option B+ programme. We found that both health workers and participants in the programme have a relatively clear understanding of the benefits of adhering to their treatment; though a more nuanced understanding and thus emphasis in counselling on side effects, is critical to helping patients adhere.
自2012年以来，世界卫生组织推荐使用预防母婴传播方案B+来减少垂直传播，但仍存在诸多依从性挑战。我们在基线阶段开展了一项定性研究，采用六次焦点小组讨论和14次深入访谈，以探究乌干达国家预防母婴传播方案B+项目中感染艾滋病毒的孕妇和产后妇女以及医护人员对预防母婴传播方案B+策略的知识、信念、态度和挑战。运用主题分析法对数据进行分析，以社会生态模型为理论基础，捕捉潜在和显性内容，从而从背景角度理解关键利益相关者对有效的方案B+干预措施的需求。总体而言，在所有研究参与者中，我们发现了贯穿社会生态模型各个层面的方案B+依从性的多层次障碍。与该模型一致，我们的研究揭示了个人、人际关系、组织和社会层面的障碍。一些个人信念，如认为婴儿的健康比母亲的健康更重要，组织层面（医护人员的消极态度和行为），结构性因素如贫困、工作冲突、恐惧以及与社区污名相关的缺乏披露，都是妇女坚持方案B+项目的关键障碍。我们发现，医护人员和项目参与者对坚持治疗的益处都有相对清晰的理解；不过，对副作用有更细致入微的理解并因此在咨询中加以强调，对于帮助患者坚持治疗至关重要。
