ICMR - National AIDS Research Institute, Pune, India.
Tata Institute of Social Sciences, Mumbai, India.
BMC Health Serv Res. 2024 Jan 4;24(1):24. doi: 10.1186/s12913-023-10500-z.
India has rolled out Early Infant Diagnosis (EID) program for HIV infection in all states. EID program consists of testing of Infants exposed to HIV periodically over 18 months of age which is a multi-step complex testing cascade. Caregivers represent the primary beneficiary of EID program i.e., infants exposed to HIV and face multiple challenges to access EID services. As part of national EID program outcome assessment study, this study narrates caregivers' perspectives on barriers and facilitators to access and utilize EID services.
The study was conducted in 31 integrated counselling and testing centres (ICTCs) located in 11 high burden HIV states. A total of 66 in-depth interviews were conducted with caregivers' of infants enrolled in EID program. Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilization from caregivers' perspectives.
The stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of Anti-Retroviral Therapy (ART) for infants exposed to HIV. On supply side (health system-level), accessibility of healthcare facility with EID services was reported as a key barrier. The distance, time and cost were key concerns. Many caregivers faced difficulties to remember the details of complex EID test schedule and relied on a phone call from ICTC counsellor for next due EID test. Delayed EID test results and lack of communication of test results to caregiver were reported as primary barriers for completing the EID test cascade.
The study reports caregiver-level and health system-level barriers and facilitators for access to EID services from the caregivers' perspectives. While, decentralisation and single window approaches can improve the access, timely communication of test results to the caregiver also need to be built in with appropriate use of technology. A holistic intervention including PLHIV support networks and the peer-led support mechanisms would be useful to address societal factors.
The study findings have high significance for developing program implementation strategies to improve access and to build right-based and patient-centred EID services.
印度已在所有邦推出了针对艾滋病毒感染的早期婴儿诊断（EID）计划。EID 计划包括定期检测在 18 个月以上暴露于艾滋病毒的婴儿，这是一个多步骤的复杂检测链。护理人员是 EID 计划的主要受益者，即接触艾滋病毒的婴儿，并面临着获得 EID 服务的多重挑战。作为国家 EID 计划结果评估研究的一部分，本研究讲述了护理人员对获得和利用 EID 服务的障碍和促进因素的看法。
该研究在 11 个艾滋病毒负担沉重的邦的 31 个综合咨询和检测中心（ICTC）进行。共对 66 名参加 EID 计划的婴儿的护理人员进行了深入访谈。采用主题分析方法，帮助确定从护理人员角度看待获得 EID 服务和利用的障碍和促进因素的主题。
社会上普遍存在的对艾滋病毒的污名和歧视仍然是一个关键的需求方（护理人员层面）障碍。艾滋病毒状况的非披露或选择性披露导致错过了或延迟了 EID 检测，也导致了接触艾滋病毒的婴儿的 HIV 诊断和抗逆转录病毒治疗（ART）的延迟。在供应方（卫生系统层面），能够获得提供 EID 服务的医疗机构被报告为一个关键障碍。距离、时间和费用是主要关注点。许多护理人员难以记住复杂的 EID 测试时间表的细节，并且依赖于 ICTC 顾问的电话通知下一次 EID 测试。EID 测试结果的延迟以及未能将测试结果告知护理人员被报告为完成 EID 测试链的主要障碍。
该研究报告了从护理人员角度看待获得 EID 服务的护理人员层面和卫生系统层面的障碍和促进因素。虽然权力下放和单一窗口方法可以改善获得服务的机会，但也需要建立及时向护理人员传达测试结果的机制，并适当利用技术。综合干预措施包括艾滋病毒感染者支持网络和同行领导的支持机制，将有助于解决社会因素。
研究结果对制定提高获得机会和建立基于权利和以患者为中心的 EID 服务的方案实施策略具有重要意义。
