University of North Carolina Project, Lilongwe, Malawi and University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA.
University of North Carolina at Chapel Hill, Nursing.
Malawi Med J. 2021 Sep;33(3):178-185. doi: 10.4314/mmj.v33i3.5.
High HIV infection and fertility rates contributed to over 12,000 children acquiring HIV from their mothers in 2011 in Malawi. To prevent mother-to-child transmission of HIV, Malawi adopted the Option B+ guidelines, and for three years, the University of North Carolina (UNC) Project provided support to strengthen guideline implementation in 134 health centres. Little is known about how implementation support strategies are delivered in low resource countries or contextual factors that may influence their delivery. The limited descriptions of support strategies and salient contextual factors limits efforts to replicate, target, and further refine strategies. Guided by the Interactive Systems Framework for Dissemination and Implementation, this study describes factors influencing implementation of support strategies and how they impacted health center staff capacity to implement Option B+ in Malawi.
A qualitative multi-case study design was applied. Data were collected through site visits to 4 heath centres (2 low- and 2-high performing centres). We interviewed 18 support providers and recipients between October 2014 and October 2015. Data were analysed using content, thematic, and cross-case analysis.
Four categories of strategies were used to support Option B+ guidelines implementation: training, technical assistance (TA), tools, and resources. All heath-centres implemented Option B+ guidelines for care provided between the antenatal and labor and delivery periods. Gaps in Option B+ implementation occurred during community activities and during post-delivery care, including gaps in testing of children to ascertain their HIV status at 6 weeks, 12 months, and 24 months. Salient contextual factors included staffing shortages, transportation challenges, limited space and infrastructure, limited stocks of HIV testing kits, and large patient populations.
Understanding factors that influence implementation support strategies and delivery of the Option B+ guidelines, such as availability of staff and other materials/drug resources, is critical to designing effective implementation support for low resource settings.
在马拉维，2011 年，由于艾滋病毒感染率和生育率居高不下，导致超过 12000 名儿童从母亲那里感染艾滋病毒。为了防止艾滋病毒母婴传播，马拉维通过了 B+方案，北卡罗来纳大学（UNC）项目在三年内为加强 134 个保健中心的准则实施提供了支持。人们对资源匮乏国家实施支持战略的方式或可能影响其实施的背景因素知之甚少。对支持战略的描述有限，重要的背景因素有限，限制了对战略的复制、定位和进一步完善。本研究以传播和实施的互动系统框架为指导，描述了影响支持战略实施的因素，以及这些因素如何影响卫生中心工作人员实施马拉维 B+方案的能力。
采用定性多案例研究设计。数据通过对 4 个保健中心（2 个低绩效中心和 2 个高绩效中心）的实地考察收集。我们在 2014 年 10 月至 2015 年 10 月期间采访了 18 名支持提供者和接受者。使用内容分析、主题分析和跨案例分析对数据进行分析。
有四类战略用于支持 B+方案实施：培训、技术援助（TA）、工具和资源。所有保健中心都在产前和分娩期间实施了 B+方案的护理准则。在社区活动和产后护理期间，B+方案的实施出现了差距，包括在 6 周、12 个月和 24 个月时，对儿童进行艾滋病毒检测以确定其艾滋病毒状况的差距。突出的背景因素包括人员配备不足、交通挑战、有限的空间和基础设施、艾滋病毒检测试剂盒库存有限以及大量的患者人群。
了解影响实施支持战略和 B+方案实施的因素，如人员配备情况以及其他材料/药品资源的可用性，对于为资源匮乏环境设计有效的实施支持至关重要。
