Kazibwe Andrew, Olal Emmanuel, Ojok Andrew Mijumbi, Kigongo John Vianney, Kafumbe Henry, Niwampeire Maria Prima, Toskin Charity Gloria, Ondo Doreen, Nabitaka Linda Kisaakye, Mwine Patience, Kagimu David, Lawino Anna, Etukoit Michael Bernard
The AIDS Support Organisation (TASO), Mulago Hospital Complex, P. O. Box 10443, Kampala, Uganda.
Clinton Health Access Initiative (CHAI), Plot 8, Moyo Close, Kampala, Uganda.
BMC Health Serv Res. 2025 May 1;25(1):626. doi: 10.1186/s12913-025-12797-4.
Elimination of vertical transmission of HIV, syphilis and hepatitis B is part of the global aspiration to end the three infections as public health threats by 2030. Whereas global and national policy guidelines recommend integration of screening, prevention and treatment for the three infections in maternal and child health (MCH) service delivery points, progress has been slow. We aimed to explore the health system factors that facilitate and hinder optimal integration of triple elimination services within the MCH platforms.
This was a cross-sectional, explanatory mixed methods multi-site study implemented in two regions of Uganda, conducted in July - August 2024. Firstly, we used an observation checklist to assess for the availability of services and commodities required for provision of triple elimination care at 20 health facilities (two regional referral hospitals, two general hospitals, two specialized outpatient TASO clinics, five HCIVs, eight HCIIIs and one HCII), and computed a percentage service and commodity availability score for each site, and average for the sites. We then used findings from this assessment to guide open-ended probing during key informant interviews and focus group discussions among ten key informants and 43 focus group discussion participants. Interviews and discussions were recorded, transcribed verbatim, and then analysed manually. We categorized responses as either facilitators or barriers and extracted quotes, by theme, based on the World Health Organization's health systems building blocks framework.
The average percentage score of service and commodity availability was 61.8% (range: 46.4-78.6%) in Acholi region and 66.1% (range: 53.6-78.6%) in Teso region. We found that presence of trained focal persons, district accountability fora, routine data collection and utilization, and availability of motivated community health workers facilitated triple elimination service integration. Key barriers included limited district health team engagement, frequent stock-outs of diagnostic and treatment commodities, health personnel shortages and high reporting burden.
Health facility service readiness and availability percentage scores differed across facilities and between the two regions. Several health system factors facilitate integrated service provision for elimination of HIV, syphilis and hepatitis B vertical transmission. This integration is, however, constrained by a number of health system barriers. Further implementation research could contribute to addressing the various health system constraints and adoption of strategies for service integration tailored to site contexts.
消除艾滋病毒、梅毒和乙型肝炎的垂直传播是全球在2030年将这三种感染作为公共卫生威胁予以终结这一愿景的一部分。尽管全球和国家政策指南建议在妇幼保健（MCH）服务点整合这三种感染的筛查、预防和治疗，但进展一直缓慢。我们旨在探讨促进和阻碍在妇幼保健平台内最佳整合三重消除服务的卫生系统因素。
这是一项于2024年7月至8月在乌干达两个地区开展的横断面、解释性混合方法多地点研究。首先，我们使用一份观察清单来评估20家卫生设施（两家地区转诊医院、两家综合医院、两家专门的门诊TASO诊所、五家HCIV、八家HCIII和一家HCII）提供三重消除护理所需服务和商品的可获得性，并计算每个地点的服务和商品可获得性百分比得分以及各地点的平均得分。然后，我们利用该评估结果来指导在10名关键信息提供者和43名焦点小组讨论参与者进行的关键信息提供者访谈和焦点小组讨论中的开放式探究。访谈和讨论进行了记录、逐字转录，然后进行人工分析。我们将回答归类为促进因素或障碍，并根据世界卫生组织的卫生系统构建模块框架按主题提取引述。
阿乔利地区服务和商品可获得性的平均百分比得分为61.8%（范围：46.4 - 78.6%），特索地区为66.1%（范围：53.6 - 78.6%）。我们发现，有经过培训的协调人、地区问责论坛、常规数据收集和利用以及有积极性的社区卫生工作者的存在促进了三重消除服务的整合。主要障碍包括地区卫生团队参与有限、诊断和治疗商品频繁缺货、卫生人员短缺以及报告负担过重。
不同设施以及两个地区之间的卫生设施服务准备情况和可获得性百分比得分存在差异。若干卫生系统因素促进了消除艾滋病毒、梅毒和乙型肝炎垂直传播的综合服务提供。然而，这种整合受到一些卫生系统障碍的限制。进一步的实施研究有助于解决各种卫生系统限制因素，并采用适合当地情况的服务整合策略。
