Mshweshwe-Pakela Nolundi, Mabuto Tonderai, Ntombela Nasiphi, Hlongwane Mpho, Kubeka Griffiths, Kerrigan Deanna L, Hoffmann Christopher J
The Aurum Institute, Johannesburg, South Africa.
The University of the Witwatersrand School of Public Health, Johannesburg, South Africa.
Implement Sci Commun. 2022 Feb 15;3(1):19. doi: 10.1186/s43058-022-00269-3.
HIV testing is the entry point into the HIV care continuum and critical for HIV epidemic control. Facility-based HIV testing services (HTS) reach individuals who are already seeking clinical care and engaging with the medical care system. For this reason, individuals diagnosed with HIV during facility-based HIV testing are more likely to continue into HIV care. To increase the number of PLHIV who are diagnosed and initiated on ART, in 2015, the South African Department of Health instituted Provider-Initiated Counselling and Testing (PICT) policy-encouraging healthcare providers to recommend HIV testing, but this strategy remains under-utilized. We aimed to identify key constraints to the normalization of PICT implementation in 10 Ekurhuleni District healthcare facilities in South Africa.
In-depth interviews were conducted with 40 healthcare workers (28 clinicians and 12 lay counsellors). Health care workers were purposefully selected to participate in the interviews, stratified by health facility and work category. Interviews were audio-recorded, transcribed, and translated for analysis. Thematic analysis was guided by the normalization process theory (NPT). NPT theory explains how practices are routinely embedded within organizational contexts. We used NVivo 10 software for qualitative data management.
Both clinicians and lay counsellors exhibited a clear understanding of the PICT policy- acknowledging its purpose and value. The identified barrier to normalization of PICT among clinicians was offering HIV testing based on suspicion of HIV despite understanding that PICT involves offering testing to all clients. Additionally, clinicians perceived PICT as incongruent with their clinical roles and perceived it to be lay counsellors' responsibility. The main facilitator was the participation of all healthcare workers, specifically the presence of lay counsellors, although they also faced barriers such as a lack of workspace and under-appreciation.
Use of NPT helped identify barriers that prevent the normalization of PITC and its integration into routine patient care. These barriers can be modified by low-cost interventions that promote congruence of PICT to the roles of clinicians and integrate the role of lay counsellors within the patient flow in the facility.
艾滋病毒检测是进入艾滋病毒护理连续统一体的切入点，对控制艾滋病毒流行至关重要。基于医疗机构的艾滋病毒检测服务（HTS）能够覆盖那些已经在寻求临床护理并与医疗系统有接触的个人。因此，在基于医疗机构的艾滋病毒检测中被诊断出感染艾滋病毒的个体更有可能继续接受艾滋病毒护理。为了增加接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLHIV）的数量，2015年，南非卫生部制定了由医护人员发起的咨询和检测（PICT）政策，鼓励医护人员推荐艾滋病毒检测，但这一策略仍未得到充分利用。我们旨在确定南非伊库伦尼区10家医疗机构中PICT实施常态化的关键制约因素。
对40名医护人员（28名临床医生和12名非专业咨询师）进行了深入访谈。医护人员是经过有目的地挑选出来参与访谈的，按医疗机构和工作类别进行了分层。访谈进行了录音、转录并翻译以供分析。主题分析以常态化过程理论（NPT）为指导。NPT理论解释了实践如何在组织环境中常规化地得以确立。我们使用NVivo 10软件进行定性数据管理。
临床医生和非专业咨询师都对PICT政策有清晰的理解，认可其目的和价值。临床医生中确定的PICT常态化障碍是，尽管了解PICT涉及向所有客户提供检测，但仍基于对艾滋病毒的怀疑提供艾滋病毒检测。此外，临床医生认为PICT与他们的临床角色不一致，认为这是非专业咨询师的职责。主要的促进因素是所有医护人员的参与，特别是非专业咨询师的存在，尽管他们也面临诸如工作空间不足和不受重视等障碍。
使用NPT有助于识别阻碍PITC常态化及其融入常规患者护理的障碍。这些障碍可以通过低成本干预措施加以改变，这些措施可促进PICT与临床医生角色的一致性，并将非专业咨询师的角色纳入医疗机构的患者流程中。
