加纳大阿克拉地区影响早期婴儿艾滋病毒诊断服务提供和利用的因素：一项定性研究。
Factors influencing the delivery and uptake of early infant diagnosis of HIV services in Greater Accra, Ghana: A qualitative study.
机构信息
Department of Social and Behavioural Sciences, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
出版信息
PLoS One. 2021 Feb 17;16(2):e0246876. doi: 10.1371/journal.pone.0246876. eCollection 2021.
BACKGROUND
Early Infant Diagnosis (EID) of HIV and timely initiation of Antiretroviral Therapy (ART) can significantly reduce morbidity and mortality of HIV infected infants. Despite the benefits of early infant testing, the coverage of EID of HIV services is still low in Sub-Saharan Africa, including Ghana.
OBJECTIVES
To ascertain the factors that facilitate or hinder the delivery and uptake of EID of HIV services.
METHODS
The study is a cross-sectional exploratory qualitative research conducted in two health facilities in the Greater Accra Region of Ghana. Respondents (n = 50) comprising health workers (n = 20) and HIV positive mothers (n = 30) were purposively sampled and engaged in in-depth interviews. The Nvivo 11 software and the Braun and Clarke's stages of thematic analysis were used in coding data and data analysis respectively.
RESULTS
The study found that health system factors such as inadequate Staff with sample collection skills, unavailability of vehicles to convey samples to the reference laboratory for analysis, the long turnaround time for receipt of Polymerase Chain Reaction (PCR) results, inadequate and frequent breakdown of PCR machine hindered EID service delivery. On the other hand, adequate knowledge of health workers on EID, availability of Dried Blood Spot (DBS) cards and the adoption of task shifting strategies facilitated EID service delivery. Factors such as the denial of HIV status, non-completion of the EID process due to frustrations encountered whiles accessing service and delay in receipt of PCR results served as barriers to mother's utilisation of EID services for their exposed infants. The study also identified that adequate knowledge of EID, perceived importance of EID, financial stability as well as financial support from others and the positive attitudes of health workers facilitated HIV positive mother's uptake of EID services for their exposed infants.
CONCLUSION
The factors attributing to the low coverage of EID of HIV services must be promptly addressed to improve service delivery and uptake.
背景
早期婴儿 HIV 诊断（EID）和及时启动抗逆转录病毒治疗（ART）可以显著降低 HIV 感染婴儿的发病率和死亡率。尽管早期婴儿检测有很多好处，但在包括加纳在内的撒哈拉以南非洲地区，EID 艾滋病毒服务的覆盖率仍然很低。
目的
确定促进或阻碍 EID 艾滋病毒服务提供和利用的因素。
方法
这项研究是在加纳大阿克拉地区的两家卫生机构进行的横断面探索性定性研究。受访者（n=50）包括卫生工作者（n=20）和 HIV 阳性母亲（n=30），采用目的抽样法进行深入访谈。Nvivo 11 软件和 Braun 和 Clarke 的主题分析阶段分别用于数据编码和数据分析。
结果
研究发现，卫生系统因素，如采集样本的工作人员技能不足、没有车辆将样本送往参考实验室进行分析、聚合酶链反应（PCR）结果的接收时间长、PCR 机不足且频繁出现故障，这些都阻碍了 EID 服务的提供。另一方面，卫生工作者对 EID 的充分了解、DBS 卡的可用性以及任务转移策略的采用促进了 EID 服务的提供。一些因素，如拒绝 HIV 状况、由于在获取服务时遇到挫折而未能完成 EID 流程以及 PCR 结果的延迟，这些都成为母亲利用 EID 服务为其暴露婴儿进行检测的障碍。研究还发现，对 EID 的充分了解、对 EID 的重视程度、经济稳定以及他人的经济支持和卫生工作者的积极态度，都促进了 HIV 阳性母亲为其暴露婴儿接受 EID 服务。
结论
必须迅速解决导致 EID 艾滋病毒服务覆盖率低的因素，以改善服务的提供和利用。
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