Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
BMC Health Serv Res. 2024 Mar 27;24(1):379. doi: 10.1186/s12913-024-10631-x.
Although Cotrimoxazole preventive therapy (CPT) has shown to be highly efficacious in reducing morbidity and mortality among people living with Human immunodeficiency virus (HIV) under 'ideal world' study conditions, operational challenges are limiting its effectiveness when implementing in countries most affected by the HIV epidemic. The fact that Mozambican authorities reported high coverage of CPT among patients with HIV, has led to this qualitative case study aimed at exploring possible factors responsible for the successful implementation of CPT in the Province of Maputo.
Between February and April 2019, we individually interviewed nine governmental stakeholders, including the person responsible for the HIV Program, the person responsible for the TB Program and the person responsible for Pharmaceutical management at three administrative levels (central, provincial and district level). Interviews were recorded, transcribed, and analysed thematically using MAXQDA Analytics Pro. Findings were translated from Portuguese into English.
Five themes iteratively emerged: (a) Role of governance & leadership, (b) Pharmaceutical strategies, (c) Service delivery modifications, (d) Health care provider factors, and (e) Patients' perspectives. Interviews revealed that continuous supply of cotrimoxazole (CTZ) had been facilitated through multiple-source procurement and a push-pull strategy. One part of CTZ arrived in kits that were imported from overseas and distributed to public health facilities based on their number of outpatient consultations (push strategy). Another part of CTZ was locally produced and distributed as per health facility demand (pull strategy). Strong district level accountability also contributed to the public availability of CTZ. Interviewees praised models of differentiated care, the integrated HIV service delivery and drug delivery strategies for reducing long queues at the health facility, better accommodating patients' needs and reducing their financial and organisational burden.
This study presents aspects that governmental experts believed to be key for the implementation of CPT in the Province of Maputo, Mozambique. Enhancing the implementation outcomes - drug availability and feasibility of the health facility-based service delivery - seemed crucial for the implementation progress. Reasons for the remarkable patient acceptability of CPT in our study setting should be further investigated.
尽管复方新诺明预防疗法（CPT）在“理想世界”的研究条件下已被证明对降低艾滋病毒（HIV）感染者的发病率和死亡率非常有效，但在受 HIV 流行影响最严重的国家实施时，其实施面临的操作挑战限制了其效果。莫桑比克当局报告称，HIV 感染者的 CPT 覆盖率很高，这导致了这项定性案例研究，旨在探索莫桑比克马普托省成功实施 CPT 的可能因素。
2019 年 2 月至 4 月，我们对 9 名政府利益攸关方进行了个人访谈，包括 HIV 项目负责人、结核病项目负责人以及三个行政级别（中央、省和地区）的药物管理负责人。访谈进行了录音、转录，并使用 MAXQDA Analytics Pro 进行了主题分析。研究结果从葡萄牙语翻译成了英语。
五个主题反复出现：（a）治理和领导作用，（b）药物策略，（c）服务提供方式的改变，（d）医疗保健提供者的因素，以及（e）患者的观点。访谈表明，通过多渠道采购和推-拉策略，持续供应复方新诺明（CTZ）已成为可能。一部分 CTZ 装在从海外进口的试剂盒中，根据门诊就诊人数分配给公共卫生机构（推策略）。另一部分 CTZ 是根据卫生机构的需求生产和分配的（拉策略）。强有力的区级问责制也有助于 CTZ 的普及。受访者称赞了差异化护理模式、整合的 HIV 服务提供和药物提供策略，这些策略减少了卫生机构的长队，更好地满足了患者的需求，减轻了他们的经济和组织负担。
本研究介绍了莫桑比克马普托省政府专家认为实施 CPT 的关键方面。增强实施结果——药物的可获得性和基于卫生机构的服务提供的可行性——似乎对实施进展至关重要。我们研究环境中 CPT 患者接受度显著的原因应进一步调查。
