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首页> 美国卫生研究院文献>SAHARA J : Journal of Social Aspects of HIV/AIDS Research Alliance >The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation uptake and sustainability
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The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation uptake and sustainability

机译：预防母婴传播艾滋病毒的致命弱点：议定书的实施吸收和可持续性

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The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.
机译：联合国艾滋病毒和艾滋病联合规划署提议到2015年在南非将艾滋病毒的垂直传播从约72200例减少到约8300例新感染儿童。但是，文化，基础设施和社会经济方面的障碍阻碍了预防母婴传播（PMTCT）协议的实施，在农村地区解决这些障碍的潜在解决方案的研究特别有限。这项研究试图确定农村SA中PMTCT协议的实施，采用和可持续性的挑战和解决方案。与地区负责人，诊所领导，工作人员和来自12个乡村诊所的患者进行了48次定性访谈，12个焦点小组讨论（n = 75）和一个为期两天的研讨会（n = 32参与者）。使用实施研究综合框架（CFIR）评估了PMTCT协议的交付和采用情况；出现了与挑战和解决方案相关的15个主题。干预特征主题包括PMTCT培训和HIV血清状况披露。外部主题包括设施空间，健康记录管理和人员短缺；内部设置的主题包括供应使用和可用性，医患关系以及运输和计划安排。与个人特征有关的主题包括员工关系，产前检查，依从性以及文化和污名。实施过程主题包括患者教育，测试结果交付和男性参与。在农村地区发现了护理方面的重大差距。使用CFIR框架从参与者那里获得的信息为解决PMTCT实施障碍提供了宝贵的见解。不断评估和纠正PMTCT方案的实施，吸收和可持续性似乎是最大程度地预防艾滋病毒的优点。

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