引入多用途预防(MPT)方法的关键规划和政策考量:来自南非医疗服务提供者和关键利益相关者的思考
Key programmatic and policy considerations for introducing multipurpose prevention (MPT) methods: reflections from healthcare providers and key stakeholders in South Africa.
作者信息
Kutywayo Alison, Mataboge Paballo, Mthimkhulu Nqaba, Martin Catherine E, Muhwava Lorrein S, Mazibuko Mbali, Makalela Nthabiseng, Kwatsha Khanyiswa, Butler Vusile, Mullick Saiqa
机构信息
Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Front Reprod Health. 2024 Feb 20;6:1249750. doi: 10.3389/frph.2024.1249750. eCollection 2024.
INTRODUCTION
Multipurpose prevention technologies (MPTs) simultaneously prevent HIV, other sexually transmitted infections, and/or unintended pregnancy. Key gatekeepers, [healthcare providers (HCPs) and key stakeholders] require proactive engagement before product implementation. This manuscript identifies HCP demand creation strategies, key stakeholder considerations for the adoption of MPTs in South Africa.
METHODS
Formative research was conducted in three districts in three South African provinces (July to November 2022). Nurses initiating oral PrEP at facility and mobile study sites participated in 4-hour participatory workshops, exploring HIV prevention, including MPTs, demand creation strategies, and preferred MPTs training packages. Activities were observed, transcribed, and thematically analysed. Five online in-depth interviews (IDIs) with Key informants (KIs) (National/district programme implementers and technical leads) and one in person, exploring key programmatic and policy considerations for MPT adoption. IDIs were approximately 40 min long, audio recorded, transcribed, and thematically analysed.
RESULTS
Twenty-one Professional Nurses completed workshops: 19 female. Six IDIs were conducted with 4 Facility Managers, 1 NDoH representative and 1 DoH Provincial Deputy Director. All participants were females, aged 30-60+ years with >10 years' in SRH/HIV policy/advocacy/research. Community conversations and information at the clinic were the best MPT demand creation methods among HCPs. KIs identified five considerations for future MPT implementation: HCP training; demand creation and messaging; existing PrEP policy amendments; preparing users for additional choice; and sustaining MPT provision.
CONCLUSION
Contraceptive implant and oral PrEP implementation lessons learned should be proactively considered when preparing for MPT introduction. HCP training and demand creation are of particular importance before MPT introduction.
引言
多功能预防技术(MPTs)可同时预防艾滋病毒、其他性传播感染和/或意外怀孕。在产品实施之前,关键把关人(医疗保健提供者和关键利益相关者)需要积极参与。本手稿确定了医疗保健提供者的需求创造策略,以及南非采用多功能预防技术时关键利益相关者的考虑因素。
方法
2022年7月至11月在南非三个省份的三个地区进行了形成性研究。在机构和移动研究地点启动口服暴露前预防(PrEP)的护士参加了为期4小时的参与式研讨会,探讨包括多功能预防技术在内的艾滋病毒预防、需求创造策略以及首选的多功能预防技术培训包。对活动进行了观察、转录和主题分析。对关键信息提供者(国家/地区项目实施者和技术负责人)进行了五次在线深入访谈,并进行了一次面对面访谈,探讨采用多功能预防技术的关键项目和政策考虑因素。深入访谈约40分钟,进行了录音、转录和主题分析。
结果
21名专业护士完成了研讨会,其中19名女性。对4名机构经理、1名国家卫生部代表和1名卫生部省级副主任进行了6次深入访谈。所有参与者均为女性,年龄在30至60岁以上,在性健康和生殖健康/艾滋病毒政策/宣传/研究方面有超过10年的经验。社区对话和诊所信息是医疗保健提供者中最好的多功能预防技术需求创造方法。关键信息提供者确定了未来实施多功能预防技术的五个考虑因素:医疗保健提供者培训;需求创造和信息传递;现有暴露前预防政策修订;让使用者为更多选择做好准备;以及持续提供多功能预防技术。
结论
在准备引入多功能预防技术时,应积极考虑从避孕植入物和口服暴露前预防的实施中吸取的经验教训。在引入多功能预防技术之前,医疗保健提供者培训和需求创造尤为重要。