Ware Norma C, Wyatt Monique A, Nakyanzi Agnes, Naddunga Faith, Pisarski Emily E, Kyomugisha Juliet, Birungi Juliet E, Bulterys Michelle A, Kamusiime Brenda, Nalumansi Alisaati, Kasiita Vicent, Mujugira Andrew, Celum Connie L
Department of Medicine, Brigham and Women's Hospital, Boston, MA USA.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA.
Discov Health Syst. 2024;3. doi: 10.1007/s44250-024-00103-8. Epub 2024 Jun 26.
Viral suppression during pregnancy and postpartum sustains the health of mothers living with HIV and reduces risk of transmitting HIV to newborns. Point of care viral load (POC VL) testing improves viral suppression and retention in care, and is increasingly being integrated into routine health services for African pregnant women living with HIV. We examined processes of implementing POC VL testing in antenatal care and at delivery for Ugandan mothers living with HIV as part of a pilot randomized trial (Clinical Trial Number: NCT05092997).
We conducted individual qualitative interviews with 12 (of 16) clinical and research staff who implemented POC VL testing ("implementers"), and 22 (of 151) mothers who received POC VL testing using the Xpert HIV-1 Viral Load Assay (Cepheid Inc., Sunnyvale, CA, USA) as part of the trial. Implementer interviews covered knowledge, perceptions and experiences of implementing POC VL testing. Mothers' interviews covered attitudes, perceptions and experiences of receiving POC VL testing. Interview data were collected from December 2021 to September 2022. An inductive, content analytic approach was used to examine the interview transcripts. The goal was to develop thematic content categories addressing the question: How did a group of Ugandan health care providers ("implementers") approach the process of implementing POC VL testing in antenatal care and at delivery for mothers living with HIV?
The inductive analysis of implementers' and mothers' qualitative accounts yielded three themes that speak to how health care staff approached implementation of POC VL testing in the pilot randomized trial. They created an efficient system of communication and then relied on that system to coordinate POC VL testing procedures. They also looked for and found ways of increasing the speed and efficiency of the testing process. Finally, they adopted a "mother-centered" approach to implementation, prioritizing the needs, preferences, and well-being of women in planning and carrying out testing procedures.
As POC VL testing becomes more widely used across high HIV burden settings, understanding how implementers think about and approach the implementation process and what they do to make an intervention successful will be an important part of evaluating feasibility.
孕期和产后的病毒抑制可维持感染艾滋病毒母亲的健康，并降低将艾滋病毒传播给新生儿的风险。即时检测病毒载量（POC VL）可改善病毒抑制和护理依从性，并且越来越多地被纳入为感染艾滋病毒的非洲孕妇提供的常规医疗服务中。作为一项试点随机试验（临床试验编号：NCT05092997）的一部分，我们研究了乌干达感染艾滋病毒母亲在产前护理和分娩时实施POC VL检测的过程。
我们对16名实施POC VL检测的临床和研究人员中的12名（“实施者”），以及151名接受POC VL检测的母亲中的22名进行了个人定性访谈，这些母亲使用Xpert HIV-1病毒载量检测法（美国加利福尼亚州桑尼维尔市的赛沛公司）作为试验的一部分。对实施者的访谈涵盖了实施POC VL检测的知识、看法和经验。对母亲的访谈涵盖了接受POC VL检测的态度、看法和经验。访谈数据收集于2021年12月至2022年9月。采用归纳性内容分析方法来审查访谈记录。目标是开发主题内容类别，以解决以下问题：一群乌干达医疗保健提供者（“实施者”）如何在产前护理和分娩时为感染艾滋病毒的母亲实施POC VL检测？
对实施者和母亲定性描述的归纳分析产生了三个主题，这些主题说明了医疗保健人员在试点随机试验中如何实施POC VL检测。他们创建了一个高效的沟通系统，然后依靠该系统来协调POC VL检测程序。他们还寻找并找到了提高检测过程速度和效率的方法。最后，他们采用了“以母亲为中心”的实施方法，在规划和实施检测程序时优先考虑妇女的需求、偏好和福祉。
随着POC VL检测在高艾滋病毒负担地区得到更广泛的应用，了解实施者如何思考和处理实施过程，以及他们为使干预成功所采取的措施，将成为评估可行性的重要组成部分。
