Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
Department of Nursing Science, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
BMC Health Serv Res. 2023 Sep 28;23(1):1038. doi: 10.1186/s12913-023-09824-7.
Nigeria has a low uptake of early infant diagnosis (EID) of HIV despite its high pediatric HIV infection rate. Efforts to increase the EID of HIV have been limited by many factors. This research assessed EID uptake and challenges service providers experienced in providing routine care for HIV-exposed infants.
This is a mixed-method study at primary health centers (PHCs) in Lagos state, Nigeria. The quantitative component of the research was a review of the PMTCT Infant Follow-up Register at a purposive sample of 22 PHCs of Lagos State. The number of HIV-exposed infants (HEIs) returned for a dried blood sample (DBS) collection, date of collection, and the infant's EID results for one year preceding the study were captured on Research Electronic Data Capture (RedCap). In-depth interviews were conducted with service providers purposively selected per participating PHC. Electronic transcripts were analyzed using MAXQDA 2020 (VERBI Software, 2019).
Twenty-two Lagos State primary health centers participated in the research. Fifteen PHCs (68.2%) had PMTCT HIV counseling and Infant follow-up registers. Documentation of DBS sample collection was observed in 12 (54.6%) PHCs. Both DBS sample collection and EID results documentation were observed in only nine (40.9%) PHCs. In-depth interviews revealed both maternal and health systems' challenges to EID. The denial of HIV status was the only maternal factor reported as a barrier against the use of EID services. Health systems challenges include unavailability of EID services, uncertainty regarding whether EID is performed in a facility, referral to secondary health facilities for EID services (leading to losses to follow-up), and delay in getting results of EID. Task-shifting of DBS collection by nurses was suggested as means to increase access to EID services.
There is a need to expand EID services and address women's denial of HIV infection. Counseling women and linkage to available services are emphasized. Re-training of health workers on DBS collection and proper documentation of EID services were noted as key to improving the implementation of early infant diagnosis of HIV in the state.
尽管尼日利亚儿科艾滋病毒感染率很高，但早期婴儿艾滋病毒诊断（EID）的普及率却很低。增加 EID 的努力受到许多因素的限制。本研究评估了 EID 的普及率，以及服务提供者在为艾滋病毒暴露婴儿提供常规护理方面所面临的挑战。
这是在尼日利亚拉各斯州初级保健中心（PHC）进行的一项混合方法研究。研究的定量部分是对拉各斯州 22 个 PHC 进行的 PMTCT 婴儿随访登记册的审查。在研究之前的一年中，有多少艾滋病毒暴露婴儿（HEI）返回采集干血样（DBS），采集日期以及婴儿的 EID 结果都记录在 Research Electronic Data Capture（RedCap）中。根据参与的每个 PHC，有目的地对服务提供者进行了深入访谈。使用 MAXQDA 2020（VERBI Software，2019）对电子记录进行了分析。
拉各斯州的 22 个初级保健中心参与了该研究。15 个 PHC（68.2％）具有 PMTCT HIV 咨询和婴儿随访登记册。在 12 个（54.6％）PHC 中观察到 DBS 样本采集的记录。仅在 9 个（40.9％）PHC 中观察到 DBS 样本采集和 EID 结果的记录。深入访谈揭示了母婴和卫生系统对 EID 的挑战。拒绝承认艾滋病毒状况是唯一被报告为阻碍使用 EID 服务的母婴因素。卫生系统的挑战包括 EID 服务不可用，不确定设施中是否进行 EID，将婴儿转介到二级保健设施以进行 EID 服务（导致失访）以及延迟获得 EID 结果。建议将 DBS 采集任务转移给护士，以增加获得 EID 服务的机会。
需要扩大 EID 服务并解决妇女对艾滋病毒感染的否认。强调对妇女进行咨询并将其与可用服务联系起来。培训卫生工作者进行 DBS 采集和正确记录 EID 服务被认为是改善该州艾滋病毒早期婴儿诊断实施的关键。
