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1.
BMC Health Serv Res ; 13: 189, 2013 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-23705793

RESUMO

BACKGROUND: Routine HIV counselling and testing as part of antenatal care has been institutionalized in Uganda as an entry point for pregnant women into the prevention of mother-to-child transmission of HIV (PMTCT) programme. Understanding how women experience this mode of HIV testing is important to generate ideas on how to strengthen the PMTCT programme. We explored pregnant HIV positive and negative women's experiences of routine counselling and testing in Mbale District, Eastern Uganda and formulated suggestions for improving service delivery. METHODS: This was a qualitative study conducted at Mbale Regional Referral Hospital in Eastern Uganda between January and May 2010. Data were collected using in-depth interviews with 30 pregnant women (15 HIV positive and 15 HIV negative) attending an antenatal clinic, six key informant interviews with health workers providing antenatal care and observations. Data were analyzed using a content thematic approach. RESULTS: Prior to attending their current ANC visit, most women knew that the hospital provided HIV counselling and testing services as part of antenatal care (ANC). HIV testing was perceived as compulsory for all women attending ANC at the hospital but beneficial, for mothers, especially those who test HIV positive and their unborn babies. Most HIV positive women were satisfied with the immediate counselling they received from health workers, but identified the need to provide follow up counselling and support after the test, as areas for improvement. However, most HIV negative women mentioned that they were given inadequate attention during post-test counselling. This left them with unanswered questions and, for some, doubts about the negative test results. CONCLUSIONS: In this setting, routine HIV counselling and testing services are known and acceptable to mothers. There is need to strengthen post-test and follow up counselling for both HIV positive and negative women in order to maximize opportunities for primary and post exposure HIV prevention. Partnerships and linkages with people living with HIV, especially those in existing support groups such as those at The AIDS Support Organization (TASO), may help to strengthen counselling and support for pregnant women. For effective HIV prevention, women who test HIV negative should be supported to remain negative.


Assuntos
Aconselhamento , Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Complicações Infecciosas na Gravidez/diagnóstico , Gestantes/psicologia , Adolescente , Adulto , Área Programática de Saúde , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Soropositividade para HIV/psicologia , Humanos , Entrevistas como Assunto , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa , Programas Médicos Regionais , População Rural , Classe Social , Uganda , Adulto Jovem
2.
J Int AIDS Soc ; 15(2): 17429, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22905360

RESUMO

INTRODUCTION: Disclosure of HIV serostatus by women to their sexual partners is critical for the success of the prevention of mother-to-child transmission of HIV (PMTCT) programme as an integrated service in antenatal care. We explored pregnant HIV-positive and HIV-negative women's partner disclosure experiences and support needs in eastern Uganda. METHODS: This was a qualitative study conducted at Mbale Regional Referral Hospital in eastern Uganda between January and May 2010. Data collection was through in-depth interviews with 15 HIV-positive and 15 HIV-negative pregnant women attending a follow up antenatal clinic (ANC) at Mbale Hospital, and six key informant interviews with health workers at the clinic.Data management was done using NVivo version 9, and a content thematic approach was used for analysis. RESULTS: All HIV-negative women had disclosed their HIV status to their sexual partners but expressed need for support to convince their partners to also undergo HIV testing.Women reported that their partners often assumed that they were equally HIV-negative and generally perceived HIV testing in the ANC as a preserve for women. Most of the HIV-positive women had not disclosed their HIV status to sexual partners for fear of abandonment, violence and accusation of bringing HIV infection into the family. Most HIV-positive women deferred disclosure and requested health workers' support in disclosure. Those who disclosed their positive status generally experienced positive responses from their partners. CONCLUSIONS: Within the context of routine HIV testing as part of the PMTCT programme, most women who test HIV-positive find disclosure of their status to partners extremely difficult. Their fear of disclosure was influenced by the intersection of gender norms, economic dependency, women's roles as mothers and young age. Pregnant HIV-negative women and their unborn babies remained at risk of HIV infection owing to the resistance of their partners to go for HIV testing. These findings depict a glaring need to strengthen support for both HIV-positive and HIV-negative women to maximize opportunities for HIV prevention.


Assuntos
Infecções por HIV/psicologia , Relações Interpessoais , Complicações Infecciosas na Gravidez/psicologia , Cônjuges/psicologia , Revelação da Verdade , Adolescente , Adulto , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Gestantes , Parceiros Sexuais/psicologia , Uganda , Adulto Jovem
3.
BMC Health Serv Res ; 12: 3, 2012 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-22222064

RESUMO

BACKGROUND: The implementation and utilization of programmes for the prevention of mother-to-child transmission (PMTCT) of HIV in most low income countries has been described as sub-optimal. As planners and service providers, the views of health workers are important in generating priorities to improve the effectiveness of the PMTCT programme in Uganda. We explored the lessons learnt by health workers involved in the provision of PMTCT services in eastern Uganda to better understand what more needs to be done to strengthen the PMTCT programme. METHODS: A qualitative study was conducted at Mbale Regional Referral Hospital, The AIDS Support Organisation (TASO) Mbale and at eight neighbouring health centres in eastern Uganda, between January and May 2010. Data were collected through 24 individual interviews with the health workers involved in the PMTCT programme and four key informants (2 district officials and 2 officials from TASO). Data were analyzed using the content thematic approach. Study themes and sub-themes were identified following multiple reading of interview transcripts. Relevant quotations have been used in the presentation of study findings. RESULTS: The key lessons for programme improvement were: ensuring constant availability of critical PMTCT supplies, such as HIV testing kits, antiretroviral drugs (ARVs) for mothers and their babies, regular in-service training of health workers to keep them abreast with the rapidly changing knowledge and guidelines for PMTCT, ensuring that lower level health centres provide maternity services and ARVs for women in the PMTCT programme and provision of adequate facilities for effective follow-up and support for mothers. CONCLUSIONS: The voices of health workers in this study revealed that it is imperative for government, civil society organizations and donors that the PMTCT programme addresses the challenges of shortage of critical PMTCT supplies, continuous health worker training and follow-up and support for mothers as urgent needs to strengthen the PMTCT programme.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/transmissão , Pessoal de Saúde/psicologia , Promoção da Saúde/organização & administração , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez , Desenvolvimento de Programas/métodos , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Gravidez , Pesquisa Qualitativa , Uganda
4.
AIDS Care ; 20(10): 1242-50, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19012083

RESUMO

Although China's government is rapidly expanding access to antiretroviral therapy, little is known about barriers to adherence among Chinese HIV-infected patients, particularly among injection drug users. To better understand barriers to antiretroviral treatment adherence, we conducted a qualitative research study, using both focus group and key informant methods, among 36 HIV-positive men and women in Dali, in southwestern China. All interviews utilized semi-structured question guides and were conducted in Mandarin, audio-recorded and translated into English for analysis. The most commonly cited adherence challenges were stigma, including secondary stigma experienced by family members; mental health issues; and economic concerns, particularly related to finding and maintaining employment. Distinctive gender differences emerged, partly due to previous heroin use among male respondents. Optimizing adherence may require that antiretroviral therapy programs be linked to other services, including drug addiction treatment, mental health services and vocational treatment and support. HIV care and service providers and policy makers in China responsible for HIV treatment should be aware of these important barriers to adherence.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Adulto , China , Feminino , Grupos Focais , Infecções por HIV/economia , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Preconceito , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
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