Sabin Lucie, Haghparast-Bidgoli Hassan, Thapaliya Bibhu, Chand Obindra, Bhattarai Sanju, Arjyal Abriti, Saville Naomi
Institute for Global Health, University College London, London, United Kingdom.
Swisscontact, Kathmandu, Nepal.
PLOS Glob Public Health. 2024 Oct 11;4(10):e0003006. doi: 10.1371/journal.pgph.0003006. eCollection 2024.
In Nepal, national guidelines recommend free HIV and syphilis screening for pregnant women at their first antenatal visit, using an opt-out approach. However, screening uptake is low and the guidelines do not include hepatitis B screening. It is essential to understand the factors influencing the implementation of integrated screening for HIV, syphilis, and hepatitis B, as recommended by WHO, to improve uptake and prevent vertical transmission. This study explored the knowledge, attitudes, and perceptions of pregnant women, their families, healthcare providers and policymakers on integrated prenatal screening. We conducted 12 in-depth interviews with pregnant women, 10 with their husbands and 4 with mothers-in-law in Kapilvastu and Kathmandu. In addition, we interviewed 7 health workers and 4 decision-makers. These interviews were sufficient to reach saturation. Data were analysed using a thematic content analysis. A combination of the social-ecological model and the WHO building blocks provided a theoretical framework for interpreting data. The analysis showed that antenatal screening in Nepal involved many stakeholders and was influenced by various factors. Implementation issues were found in the building blocks service delivery, health workforce and medical products. Husbands and in-laws play an important role in the acceptance of screening by pregnant women, especially in rural areas. High levels of stigma and discrimination against people with sexually transmitted diseases were reported, and knowledge of hepatitis B and syphilis was low. Access and uptake of screening could be improved through rapid testing, by strengthening the health system and by integrating hepatitis B screening through an opt-out approach like that for HIV and syphilis. Effective community involvement through awareness campaigns and investment in lower-level health facilities is essential to improve screening rates. This study provides information for decision-makers about challenges in implementing integrated screening to guide the design of targeted interventions to reduce vertical transmission.
在尼泊尔，国家指南建议在孕妇首次产前检查时采用主动筛查的方式，为其免费进行艾滋病毒和梅毒检测。然而，筛查的接受率较低，且该指南未包括乙型肝炎筛查。了解影响世界卫生组织所建议的艾滋病毒、梅毒和乙型肝炎综合筛查实施的因素，对于提高接受率和预防垂直传播至关重要。本研究探讨了孕妇及其家人、医疗服务提供者和政策制定者对产前综合筛查的知识、态度和看法。我们在卡皮拉瓦斯图和加德满都对12名孕妇、10名孕妇的丈夫和4名婆婆进行了深入访谈。此外，我们还采访了7名卫生工作者和4名决策者。这些访谈足以达到饱和状态。数据采用主题内容分析法进行分析。社会生态模型和世界卫生组织的构建模块相结合，为解释数据提供了理论框架。分析表明，尼泊尔的产前筛查涉及许多利益相关者，并受到多种因素的影响。在构建模块的服务提供、卫生人力和医疗产品方面发现了实施问题。丈夫和公婆在孕妇接受筛查方面发挥着重要作用，尤其是在农村地区。据报告，对性传播疾病患者存在高度的耻辱感和歧视，对乙型肝炎和梅毒的了解程度较低。通过快速检测、加强卫生系统以及像对艾滋病毒和梅毒那样采用主动筛查的方式将乙型肝炎筛查纳入其中，可以提高筛查的可及性和接受率。通过开展提高认识运动以及对基层卫生设施进行投资，让社区有效参与，对于提高筛查率至关重要。本研究为决策者提供了有关实施综合筛查挑战的信息，以指导设计有针对性的干预措施，减少垂直传播。
