首页> 外文OA文献 >Integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at antenatal facilities in western Kenya: a qualitative study exploring end-users’ perspectives of appropriateness, acceptability and feasibility
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Integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at antenatal facilities in western Kenya: a qualitative study exploring end-users’ perspectives of appropriateness, acceptability and feasibility

机译:肯尼亚西部产前设施的艾滋病毒,梅毒,疟疾和贫血的综合护理测试(POCT):探索最终用户的适当性,可接受性和可行性的定性研究

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摘要

Abstract Background HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes in sub-Saharan Africa yet testing coverage for conditions other than HIV is low. Availing point-of-care tests (POCTs) at rural antenatal health facilities (dispensaries) has the potential to improve access and timely treatment. Fundamental to the adoption of and adherence to new diagnostic approaches are healthcare workers’ and pregnant women’s (end-users) buy-in. A qualitative approach was used to capture end-users’ experiences of using POCTs for HIV, syphilis, malaria and anaemia to assess the appropriateness, acceptability and feasibility of integrated testing for ANC. Methods Seven dispensaries were purposively selected to implement integrated point-of-care testing for eight months in western Kenya. Semi-structured interviews were conducted with 18 healthcare workers (14 nurses, one clinical officer, two HIV testing counsellors, and one laboratory technician) who were trained, had experience doing integrated point-of-care testing, and were still working at the facilities 8–12 months after the intervention began. The interviews explored acceptability and relevance of POCTs to ANC, challenges with testing, training and supervision, and healthcare workers’ perspectives of client experiences. Twelve focus group discussions with 118 pregnant women who had attended a first ANC visit at the study facilities during the intervention were conducted to explore their knowledge of HIV, syphilis, malaria, and anaemia, experience of ANC point-of-care testing services, treatments received, relationships with healthcare workers, and experience of talking to partners about HIV and syphilis results. Results Healthcare workers reported that they enjoyed gaining new skills, were enthusiastic about using POCTs, and found them easy to use and appropriate to their practice. Initial concerns that performing additional testing would increase their workload in an already strained environment were resolved with experience and proficiency with the testing procedures. However, despite having the diagnostic tools, general health system challenges such as high client to healthcare worker volume ratio, stock-outs and poor working conditions challenged the delivery of adequate counselling and management of the four conditions. Pregnant women appreciated POCTs, but reported poor healthcare worker attitudes, drug stock-outs, and fear of HIV disclosure to their partners as shortcomings to their ANC experience in general. Conclusion This study provides insights on the acceptability, appropriateness, and feasibility of integrating POCTs into ANC services among end-users. While the innovation was desired and perceived as beneficial, future scale-up efforts would need to address health system weaknesses if integrated testing and subsequent effective management of the four conditions are to be achieved.
机译:摘要背景艾滋病毒,梅毒,疟疾和贫血是亚撒非洲撒哈拉以南非洲的不利妊娠结果的可预防原因,但艾滋病病毒以外的病症覆盖率低。在农村产前卫生设施(零类)的照明测试(POCTS)有可能改善进入和及时治疗。采用和遵守新诊断方法的基础是医疗职工和孕妇(最终用户)买入。一种定性方法用于捕获用于艾滋病毒,梅毒,疟疾和贫血的POCT的最终用户的经验,以评估ANC的综合测试的适当性,可接受性和可行性。方法有七种分类被任意地选择,以在肯尼亚西部实施八个月的综合治疗测试。有18名医疗工作者(14名护士,一名临床官员,两名艾滋病毒检测辅导员和一个实验室技术人员)进行了半结构性访谈,培训了培训的经验,并仍然在设施工作干预后8-12个月开始。面试探讨了对ANC,测试,培训和监督和医疗工作者的客户经验的观点的可接受性和相关性。在干预期间,与118名孕妇参加了第118名孕妇的讨论,探讨了他们对艾滋病毒,梅毒,疟疾和贫血,ANC的经验,护理的经验,治疗收到,与医疗保健工人的关系,以及与伴侣讨论艾滋病毒和梅毒结果的经验。结果医疗保健工作人员报告说,他们享受新的技能,热情地使用POCTS,并发现它们易于使用和适合他们的练习。初步担忧,执行额外测试将增加其在已经紧张的环境中的工作量,并通过测试程序进行了经验和熟练程度解决。但是,尽管具有诊断工具,但普遍存在卫生系统挑战,如高客户到医疗保健人数比,储蓄和工作条件差的挑战,挑战了四种条件的充足咨询和管理。孕妇欣赏温度,但报道了贫困的医疗保健工作者态度,毒品储备和艾滋病毒披露的恐惧,以及他们的遗物的缺点。结论本研究提供了对最终用户之间将POCTS融入ANC服务的可接受性,适当性和可行性的见解。虽然所需的创新并被视为有益,但如果要实现综合测试和随后的四种条件的有效管理,将需要解决卫生系统的弱点。

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