Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study
| العنوان: | Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study |
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| المؤلفون: | Corie Gray, Christina Zarowsky, Lisa J. Ware, Katherine Murphy, Jean Claude Mutabazi, Helen Trottier, Lorrein Shamiso Muhwava, Naomi S. Levitt, Shane A. Norris |
| المساهمون: | Division of Endocrinology and Diabetology, Faculty of Health Sciences |
| المصدر: | BMC Health Services Research BMC Health Services Research, Vol 20, Iss 1, Pp 1-18 (2020) |
| بيانات النشر: | Faculty of Health Sciences, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Health Personnel, Social Stigma, HIV prevention, Integration, HIV Infections, Health informatics, Health administration, Denialism, Prevention of mother-to-child transmission of HIV, 03 medical and health sciences, South Africa, 0302 clinical medicine, Health systems, Nursing, Acquired immunodeficiency syndrome (AIDS), Pregnancy, PMTCT service, Health care, PMTCT programme, medicine, Humans, 030212 general & internal medicine, Child, Qualitative Research, Primary health care, Acquired Immunodeficiency Syndrome, business.industry, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, Public health, Nursing research, Administrative Personnel, Infant, International health, Prenatal Care, lcsh:RA1-1270, medicine.disease, Infectious Disease Transmission, Vertical, Female, 0305 other medical science, business, Research Article |
| الوصف: | BackgroundIntegrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing primary health care (PHC) services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. This study explored the perspectives of both experts or key informants and frontline health workers (FHCWs) in South Africa on PMTCT integration into PHC in the context of post-AIDS denialism using a Complex Adaptive Systems framework.MethodsA total of 20 in-depth semi-structured interviews were conducted; 10 with experts including national and international health systems and HIV/PMTCT policy makers and researchers, and 10 FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis.ResultsExperts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programmes into PHC following its initial rollout as a stand-alone programme in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructural issues (e.g., lack of rooms, small spaces) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to polymerase-chain reaction (PCR) testing and immunisation.ConclusionsDespite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT in PHC, especially postpartum. The results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2f955aec359e87ff5969511b5650eae8 https://doi.org/10.1186/s12913-020-05381-5 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....2f955aec359e87ff5969511b5650eae8 |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |