在中低收入国家的产前保健环境中，艾滋病毒和梅毒快速诊断检测的障碍和促进因素：系统评价。

Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review.

机构信息

The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia

The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.

出版信息

BMJ Glob Health. 2022 Nov;7(11). doi: 10.1136/bmjgh-2022-009408.

DOI:10.1136/bmjgh-2022-009408

PMID:36319030

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9628546/

Abstract

BACKGROUND

Testing and treatment during pregnancy is a well-established and cost-effective prevention strategy, which relies largely on use of rapid diagnostic tests (RDTs). Yet, in many low-income and-middle-income countries, the uptake of RDTs is suboptimal. A qualitative meta-synthesis was conducted to identify the barriers and enablers to use of HIV and syphilis RDTs among pregnant women in low-income and middle-income countries.

METHODS

This review was conducted using PRISMA guidelines. Eligible studies included peer-reviewed publications, which used qualitative methods to explore HIV and syphilis RDT in antenatal care clinics in low-income and middle-income countries. Studies focusing on perspectives of pregnant women, healthcare workers and/or stakeholders were included. We used an inductive approach informed by a modified socioecological model to synthesise the data.

RESULTS

62 manuscripts met the eligibility criteria. For pregnant women, initial acceptance of the RDT and continuation in antenatal care depends on the perception that engaging in testing will be a beneficial experience for their baby and themselves, often influenced by the provision of services that are gender-sensitive, confidential, respectful, flexible and considers their well-being into the future. Local sociocultural beliefs about pregnancy and diseases, awareness of diseases and gender roles in society also influenced RDT acceptability among pregnant women. For healthcare workers, the ability to provide high-quality RDT care required ongoing training, accurate and easy to use tests, support from supervisors and communities, sufficient resources and staffing to provide services, and reliable salary. At the stakeholder level, well-developed guidelines and health system infrastructures were imperative to the delivery of RDT in antenatal clinics.

CONCLUSION

Our findings highlight clear gaps to the provision of sustainable and culturally acceptable maternal HIV and/or syphilis screening using RDTs. In addition, greater attention needs to be paid to community stakeholders in promoting the uptake of RDT in antenatal clinics.

PROSPERO REGISTRATION NUMBER

CRD42018112190.

摘要

背景

在妊娠期间进行检测和治疗是一种成熟且具有成本效益的预防策略，主要依赖于快速诊断检测（RDT）的使用。然而，在许多低收入和中等收入国家，RDT 的使用率并不理想。本研究通过定性元分析，旨在确定在低收入和中等收入国家的孕妇中使用 HIV 和梅毒 RDT 的障碍和促进因素。

方法

本研究按照 PRISMA 指南进行。合格的研究包括使用定性方法探讨在低收入和中等收入国家的产前保健诊所中使用 HIV 和梅毒 RDT 的同行评议出版物。纳入的研究重点关注孕妇、卫生保健工作者和/或利益相关者的观点。我们使用一种基于改良社会生态学模型的归纳方法对数据进行综合。

结果

62 篇论文符合入选标准。对于孕妇而言，最初接受 RDT 并继续在产前保健中接受检测取决于她们认为检测将对自己和宝宝有益的感知，这通常受到提供敏感性别、保密、尊重、灵活并考虑未来福利的服务的影响。当地对怀孕和疾病的社会文化观念、对疾病的认识以及社会中的性别角色也影响了孕妇对 RDT 的接受程度。对于卫生保健工作者而言，提供高质量的 RDT 护理需要持续的培训、准确易用的检测、主管和社区的支持、充足的资源和人员配备来提供服务，以及可靠的薪资。在利益相关者层面，完善的指南和卫生系统基础设施对于在产前诊所提供 RDT 至关重要。