Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA.
Department of Community Health and Primary Care, University of Lagos, Mushin, Lagos, Nigeria.
BMJ Open. 2021 Oct 29;11(10):e046263. doi: 10.1136/bmjopen-2020-046263.
To investigate the challenges of, and opportunities for, effective delivery of prevention of mother-to-child transmission (PMTCT) services from the perspectives of primary healthcare providers in Lagos, Nigeria.
This qualitative study consisted of nine focus groups with 59 health providers, analysed thematically.
Thirty-eight primary health facilities in central and western districts of Lagos, Nigeria.
Participants included nurses, nursing assistants, community health workers, laboratory workers, pharmacists, pharmacy technicians, monitoring and evaluation staff and medical records personnel.
Health providers' challenges included frustration with the healthcare system where unmet training needs, lack of basic amenities for effective and safe treatment practices, low wages and inefficient workflow were discussed. Providers discussed patient-level challenges, which included the practice of giving fake contact information for fear of HIV-related stigmatisation, and refusal to accept HIV-positive results and to enrol in care. Providers' suggestions for addressing PMTCT service delivery challenges included the provision of adequate supplies and training of healthcare workers. To mitigate stigmatisation, participants suggested home-based care, working with traditional birth attendants and religious institutions and designating a HIV health educator for each neighbourhood.
Findings illustrate the complex nature of PMTCT service delivery and illuminate issues at the patient and health system levels. These results may be used to inform strategies for addressing identified barriers and to improve the provision of PMTCT services, thus ensuring better outcomes for women and families.
从尼日利亚拉各斯初级卫生保健提供者的角度探讨有效提供预防母婴传播 (PMTCT) 服务所面临的挑战和机遇。
本定性研究包括 9 个焦点小组，共 59 名卫生提供者，采用主题分析法进行分析。
尼日利亚拉各斯中部和西部地区的 38 个初级卫生保健机构。
参与者包括护士、护理助理、社区卫生工作者、实验室工作人员、药剂师、药剂技术员、监测和评估人员以及医疗记录人员。
卫生提供者面临的挑战包括对医疗体系感到沮丧，其中包括未满足的培训需求、缺乏有效和安全治疗实践的基本设施、低工资和低效的工作流程等问题。提供者还讨论了患者层面的挑战，包括因害怕与 HIV 相关的污名化而提供虚假联系信息的做法，以及拒绝接受 HIV 阳性结果和注册接受护理的现象。提供者为解决 PMTCT 服务提供挑战提出了一些建议，包括提供充足的供应品和培训卫生工作者。为了减轻污名化，参与者建议提供家庭护理、与传统助产妇和宗教机构合作以及为每个社区指定一名 HIV 健康教育者。
研究结果说明了 PMTCT 服务提供的复杂性，并阐明了患者和卫生系统层面的问题。这些结果可用于为解决已确定的障碍提供信息，并改善 PMTCT 服务的提供，从而确保妇女和家庭的更好结果。
