Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study


Autoři: Catherine Wexler aff001;  May Maloba aff002;  Melinda Brown aff001;  Natabhona Mabachi aff001;  Kathy Goggin aff003;  Brad Gautney aff005;  Beryne Odeny aff001;  Sarah Finocchario-Kessler aff001
Působiště autorů: Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America aff001;  Global Health Innovations, Nairobi, Kenya aff002;  Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, United States of America aff003;  School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America aff004;  Global Health Innovations, Dallas, TX, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225642

Souhrn

Background

At-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya.

Methods

We conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIV-exposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources.

Results

Most providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before–possibly–learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier.

Discussion

While overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges.

Klíčová slova:

Decision making – HIV diagnosis and management – Infants – Labor and delivery – Nurses – Pregnancy


Zdroje

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2019 Číslo 11