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首页> 外文期刊>AIDS care. >Implementing routine provider-initiated HIV testing in public health care facilities in Kenya: a qualitative descriptive study of nurses' experiences.
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Implementing routine provider-initiated HIV testing in public health care facilities in Kenya: a qualitative descriptive study of nurses' experiences.

机译：在肯尼亚的公共卫生机构实施由服务提供者发起的例行艾滋病毒检测：对护士经历的定性描述研究。

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Routine "provider-initiated testing and counselling" (PITC) for HIV has been implemented amidst concern over how consent, confidentiality and counselling (the 3Cs) can be maintained in under-resourced health care settings. In Kenya, PITC has been rolled out since 2005, HIV prevalence is 7.1% and more than 86% of adults have not been tested. Kenyan nurses are the main cadre implementing PITC, but little is known about their experiences of incorporating HIV testing into everyday practice and the challenges faced in maintaining the 3Cs within their work environments. This study aimed to explore these issues and adopted a qualitative multi-method design using a convenience sampling approach. Two focus group discussions (total n=12) and 13 in-depth individual interviews were undertaken with nurses from 11 different public health care facilities in Nairobi and its surrounding areas (including in-patient and outpatient settings). Data were analysed thematically. Nurses identified a range of personal, client and health system challenges in the everyday application of PITC. These included (i) the contradictions of normalising a highly stigmatised disease and the difficulty in providing client-centred care within a routinised and target-oriented work culture; (ii) the challenge of dealing with ethically complex client situations in which the principles of the 3Cs could be difficult to uphold; and (iii) lack of time, resources, space and recognition within workplace environments (especially in-patient settings) that, likewise, led to problems with maintaining the 3Cs. In-patient nurses in particular identified problems associated with testing in a multi-disciplinary context, suggesting that other health professionals appeared to routinely flout the PITC guidelines. In conclusion, this study shows that the process of translating policy into practice is invariably complex and that more research is needed to explore PITC practices, particularly in in-patient settings. Nurses require supervision and support to negotiate the challenges and to fulfil their roles effectively.
机译：在担心如何在资源贫乏的医疗机构中维持同意，保密和咨询（3C）的情况下，已经实施了针对艾滋病毒的常规“提供商发起的测试和咨询”（PITC）。在肯尼亚，自2005年以来已开始实施PITC，艾滋病毒感染率为7.1％，超过86％的成年人未经检测。肯尼亚护士是实施PITC的主要干部，但是对于他们将HIV检测纳入日常实践的经验以及在工作环境中维持3C所面临的挑战知之甚少。这项研究旨在探讨这些问题，并采用便利采样方法采用了定性的多方法设计。与来自内罗毕及其周边地区（包括住院和门诊场所）的11个不同公共卫生保健机构的护士进行了两次焦点小组讨论（总计n = 12）和13次深入的个人访谈。对数据进行专题分析。护士在PITC的日常应用中发现了一系列个人，客户和卫生系统方面的挑战。其中包括：（i）使高度污名化的疾病正常化的矛盾以及在常规化和针对性的工作文化中难以提供以客户为中心的护理的矛盾; （ii）应对道德上复杂的客户情况的挑战，在这种情况下，可能难以坚持3C的原则; （iii）在工作场所环境（尤其是住院环境）中缺乏时间，资源，空间和认可度，同样导致维护3C的问题。住院护士尤其在多学科环境中发现了与测试相关的问题，这表明其他医疗专业人员似乎经常违反了PITC指南。总之，这项研究表明，将政策转化为实践的过程总是很复杂，需要更多的研究来探索PITC的实践，尤其是在住院患者中。护士需要监督和支持，以应对挑战并有效履行职责。

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