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A comprehensive review of the barriers and promoters health workers experience in delivering prevention of vertical transmission of HIV services in sub-Saharan Africa

机译：全面回顾了卫生工作者在撒哈拉以南非洲提供预防艾滋病毒垂直传播的服务中遇到的障碍和推动者

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Despite significant biomedical and policy advances, 199,000 infants and young children in sub-Saharan Africa (SSA) became infected with HIV in 2013, indicating challenges to implementation of these advances. To understand the nature of these challenges, we sought to (1) characterize the barriers and facilitators that health workers encountered delivering prevention of vertical transmission of HIV (PVT) services in SSA and (2) evaluate the use of theory to guide PVT service delivery. The PubMed and CINAHL databases were searched using keywords barriers, facilitators, HIV, prevention of vertical transmission of HIV, health workers, and their synonyms to identify relevant studies. Barriers and facilitators were coded at ecological levels according to the Determinants of Performance framework. Factors in this framework were then classified as affecting motivation, opportunity, or ability, per the Motivation-Opportunity-Ability (MOA) framework in order to evaluate domains of health worker performance within each ecological level. We found that the most frequently reported challenges occurred within the health facility level and spanned all three MOA domains. Barriers reported in 30% or more of studies from most proximal to distal included those affecting health worker motivation (stress, burnout, depression), patient opportunity (stigma), work opportunity (poor referral systems), health facility opportunity (overburdened workload, lack of supplies), and health facility ability (inadequate PVT training, inconsistent breastfeeding messages). Facilitators were reported in lower frequencies than barriers and tended to be resolutions to challenges (e.g., quality supervision, consistent supplies) or responses to an intervention (e.g., record systems and infrastructure improvements). The majority of studies did not use theory to guide study design or implementation. Interventions addressing health workers' multiple ecological levels of interactions, particularly the health facility, hold promise for far-reaching impact as distal factors influence more proximal factors. Incorporating theory that considers factors beyond the health worker will strengthen endeavors to mitigate barriers to PVT service delivery.
机译：尽管生物医学和政策取得了重大进展，但撒哈拉以南非洲（SSA）的199,000名婴幼儿在2013年仍感染了艾滋病毒，这表明在实施这些进展方面面临挑战。为了理解这些挑战的性质，我们试图（1）表征卫生工作者在SSA中提供HIV垂直传播（PVT）服务的预防过程中遇到的障碍和促进者，以及（2）评估理论指导PVT服务的提供。使用关键词障碍，促进者，艾滋病毒，预防艾滋病毒垂直传播，卫生工作者及其同义词搜索关键词PubMed和CINAHL数据库，以识别相关研究。根据绩效决定框架，在生态层面对障碍和促进者进行了编码。然后，根据动机-机会-能力（MOA）框架，将此框架中的因素归类为影响动机，机会或能力，以便评估每个生态级别内卫生工作者绩效的范围。我们发现，最常报告的挑战发生在医疗机构级别，并且跨越了所有三个MOA域。从近端到远端的研究中，有30％或更多的障碍报告为影响卫生工作者动机（压力，倦怠，抑郁），患者机会（耻辱），工作机会（转诊系统不佳），卫生设施机会（工作量过多，缺乏）的障碍。物资和卫生设施能力（PVT培训不足，母乳喂养信息不一致）。据报告，促进者的频率低于障碍物，往往是解决挑战的方法（例如，质量监督，稳定的供应）或对干预措施的响应（例如，记录系统和基础设施的改进）。大多数研究没有使用理论来指导研究设计或实施。由于远端因素会影响更多近端因素，因此针对卫生工作者的多种生态互动水平（尤其是卫生机构）的干预措施有望产生深远影响。纳入考虑了卫生工作者以外因素的理论将加强努力，以减轻PVT服务提供的障碍。

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