Court Lara, Nelson Aurelie, Taliep Reghana, Dean Sarah Schoetz, Mvududu Rufaro, Knight Lucia, Dovel Kathryn, Coates Thomas, Myer Landon, Davey Dvora L Joseph
Division of Social and Behavioural Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa.
Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
Glob Health Sci Pract. 2024 Dec 20;12(6). doi: 10.9745/GHSP-D-24-00166.
Oral pre-exposure prophylaxis (PrEP) is an effective and safe option to prevent HIV acquisition and vertical HIV transmission in pregnant and breastfeeding women. Understanding health system factors influencing the integration of PrEP into care for pregnant and breastfeeding women is key to increasing access. We explored managers' and health care workers' (HCWs) experiences with integrating PrEP into antenatal care and postnatal care services in primary health care clinics in Cape Town, South Africa.
This exploratory qualitative study used codebook thematic analysis, where HCWs were purposively, heterogeneously sampled from an implementation science study. Semistructured individual interviews were conducted with 9 managerial-level staff, and 3 focus group discussions were conducted with HCWs (nurses, midwives, and HIV counselors) providing PrEP (6-7 HCWs per group) between November 2022 and January 2023 (N=28). Interview guides covered health system facilitators, barriers, and recommendations. The Health Systems Dynamics framework guided data analysis and presentation of results.
PrEP integration into antenatal care services was described as acceptable and feasible; however, changes to HIV testing policy and indicators in breastfeeding women are needed to integrate PrEP into postnatal clinics, together with identification of mother and baby as a dyad in visits. Results showed that supportive policies facilitated wider, simplified PrEP provision. The availability and accessibility of prescribing nurses and lay HIV counselors, PrEP (both within facilities and in communities), and information about PrEP for implementers and pregnant and breastfeeding women will be pivotal to facilitating integration.
Facilitators for PrEP integration include task-shifting PrEP education and identification of women for PrEP initiation to HIV counselors, changes to national guidelines defining who can prescribe PrEP, revision and integration of PrEP training for HCWs, community-level interventions for PrEP demand creation and stigma reduction, and provision of differentiated PrEP delivery options.
口服暴露前预防（PrEP）是预防艾滋病毒感染以及预防孕妇和哺乳期妇女垂直传播艾滋病毒的一种有效且安全的方法。了解影响将PrEP纳入孕妇和哺乳期妇女护理的卫生系统因素是增加可及性的关键。我们探讨了南非开普敦初级卫生保健诊所管理人员和医护人员（HCW）将PrEP纳入产前护理和产后护理服务的经验。
这项探索性定性研究采用了编码本主题分析，医护人员是从一项实施科学研究中有目的地、异质性地抽取的。2022年11月至2023年1月期间，对9名管理级工作人员进行了半结构化个人访谈，并与提供PrEP的医护人员（护士、助产士和艾滋病毒咨询师）进行了3次焦点小组讨论（每组6 - 7名医护人员）（N = 28）。访谈指南涵盖了卫生系统的促进因素、障碍和建议。卫生系统动力学框架指导了数据分析和结果呈现。
将PrEP纳入产前护理服务被认为是可接受且可行的；然而，需要改变艾滋病毒检测政策和哺乳期妇女的指标，以便将PrEP纳入产后诊所，同时在就诊时将母婴作为一个二元组进行识别。结果表明，支持性政策有助于更广泛、更简化地提供PrEP。开处方护士和非专业艾滋病毒咨询师的可及性、PrEP（包括在医疗机构内和社区）以及为实施者和孕妇及哺乳期妇女提供的PrEP信息对于促进整合至关重要。
PrEP整合的促进因素包括将PrEP教育任务转移并由艾滋病毒咨询师识别开始PrEP的女性、改变界定谁可以开PrEP的国家指南、修订并整合医护人员的PrEP培训、开展社区层面干预以创造PrEP需求并减少耻辱感，以及提供差异化的PrEP给药选择。
