Berlacher Michelle, Mercer Timothy, Apondi Edith O, Mwangi Winfred, Were Edwin, McHenry Megan S
Indiana University School of Medicine, Department of Internal Medicine and Pediatrics, Indianapolis, Indiana 46202, USA.
The University of Texas at Dell Medical School, Department of Population Health, Austin, Texas 78712, USA & The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, KENYA.
Int J MCH AIDS. 2021;10(1):19-28. doi: 10.21106/ijma.429. Epub 2020 Dec 30.
Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework.
A framework adapted from the World Health Organization's six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and challenges of integration across each of the health system functions were evaluated to better understand this approach.
Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits and challenges of integration. Benefits of integration included convenience for families through streamlining of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV status, particularly in the context of high-volume, crowded clinical spaces.
The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system.
随着全球卫生界从针对特定疾病的急性卫生规划向为慢性病构建的护理模式转变，卫生系统整合变得越来越重要，其主要目的是加强公共部门卫生系统。在包括肯尼亚在内的撒哈拉以南非洲许多国家，预防母婴传播艾滋病毒（pMTCT）服务正被纳入一般母婴健康（MCH）诊所。本研究的目的是通过一个评估框架，评估在一个发展中的卫生系统中整合护理的益处和挑战。
采用一个改编自世界卫生组织六项关键卫生系统功能的框架，来评估肯尼亚西部pMTCT服务与一般MCH诊所的整合情况。从关键利益相关者那里收集观点，包括pMTCT和MCH项目负责人以及当地卫生服务提供者。评估了卫生系统各项功能整合的益处和挑战，以便更好地理解这种方法。
担任领导职务的关键信息提供者和MCH工作人员在整合的益处和挑战方面看法相似。整合的益处包括通过简化服务为家庭提供便利以及减少对艾滋病毒的污名化。担忧和挑战包括与艾滋病毒状况相关的保密问题，特别是在量大且拥挤的临床环境中。
本研究结果突出了需要解决的领域，以最大限度地提高pMTCT - MCH整合模式的有效性和临床流程。从这种整合中吸取的经验教训可能适用于撒哈拉以南非洲其他试图将艾滋病毒护理纳入更广泛公共部门卫生系统的地区。
