Lara Court, Aurelie Nelson, Reghana Taliep, Sarah Schoetz Dean, Rufaro Mvududu, Lucia Knight, Kathryn Dovel, Thomas Coates, Landon Myer, Dvora L Joseph Davey
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引用次数: 0
Abstract
Introduction: Oral pre-exposure prophylaxis (PrEP) is an effective and safe option to prevent HIV acquisition and vertical HIV transmission in pregnant and breastfeeding women. Understanding health system factors influencing the integration of PrEP into care for pregnant and breastfeeding women is key to increasing access. We explored managers' and health care workers' (HCWs) experiences with integrating PrEP into antenatal care and postnatal care services in primary health care clinics in Cape Town, South Africa.
Methods: This exploratory qualitative study used codebook thematic analysis, where HCWs were purposively, heterogeneously sampled from an implementation science study. Semistructured individual interviews were conducted with 9 managerial-level staff, and 3 focus group discussions were conducted with HCWs (nurses, midwives, and HIV counselors) providing PrEP (6-7 HCWs per group) between November 2022 and January 2023 (N=28). Interview guides covered health system facilitators, barriers, and recommendations. The Health Systems Dynamics framework guided data analysis and presentation of results.
Results: PrEP integration into antenatal care services was described as acceptable and feasible; however, changes to HIV testing policy and indicators in breastfeeding women are needed to integrate PrEP into postnatal clinics, together with identification of mother and baby as a dyad in visits. Results showed that supportive policies facilitated wider, simplified PrEP provision. The availability and accessibility of prescribing nurses and lay HIV counselors, PrEP (both within facilities and in communities), and information about PrEP for implementers and pregnant and breastfeeding women will be pivotal to facilitating integration.
Conclusion: Facilitators for PrEP integration include task-shifting PrEP education and identification of women for PrEP initiation to HIV counselors, changes to national guidelines defining who can prescribe PrEP, revision and integration of PrEP training for HCWs, community-level interventions for PrEP demand creation and stigma reduction, and provision of differentiated PrEP delivery options.
期刊介绍:
Global Health: Science and Practice (GHSP) is a no-fee, open-access, peer-reviewed, online journal aimed to improve health practice, especially in low- and middle-income countries. Our goal is to reach those who design, implement, manage, evaluate, and otherwise support health programs. We are especially interested in advancing knowledge on practical program implementation issues, with information on what programs entail and how they are implemented. GHSP is currently indexed in PubMed, PubMed Central, POPLINE, EBSCO, SCOPUS,. the Web of Science Emerging Sources Citation Index, and the USAID Development Experience Clearinghouse (DEC).
TOPICS:
Issued four times a year, GHSP will include articles on all global health topics, covering diverse programming models and a wide range of cross-cutting issues that impact and support health systems. Examples include but are not limited to:
Health:
Addiction and harm reduction,
Child Health,
Communicable and Emerging Diseases,
Disaster Preparedness and Response,
Environmental Health,
Family Planning/Reproductive Health,
HIV/AIDS,
Malaria,
Maternal Health,
Neglected Tropical Diseases,
Non-Communicable Diseases/Injuries,
Nutrition,
Tuberculosis,
Water and Sanitation.
Cross-Cutting Issues:
Epidemiology,
Gender,
Health Communication/Healthy Behavior,
Health Policy and Advocacy,
Health Systems,
Human Resources/Training,
Knowledge Management,
Logistics and Supply Chain Management,
Management and Governance,
mHealth/eHealth/digital health,
Monitoring and Evaluation,
Scale Up,
Youth.