背景:2011年,马拉维的艾滋病毒感染率和生育率较高,导致12,000多名儿童从母亲那里感染艾滋病毒。为了防止艾滋病毒的母婴传播,马拉维通过了备选方案B+准则,三年来,北卡罗来纳大学(UNC)项目为加强134个卫生中心的指南实施提供了支持.关于如何在资源匮乏的国家交付实施支持战略或可能影响其交付的环境因素,人们知之甚少。对支持策略和突出背景因素的有限描述限制了复制的努力,目标,进一步完善战略。在传播和实施交互式系统框架的指导下,本研究描述了影响支持策略实施的因素,以及这些因素如何影响马拉维卫生中心工作人员实施B+方案的能力.
方法:采用定性多案例研究设计。数据是通过对4个健康中心(2个低和2个高表现中心)的实地考察收集的。我们采访了2014年10月至2015年10月之间的18个支持提供者和接受者。数据分析使用内容,专题,和跨案例分析。
结果:使用了四类策略来支持选项B+指南的实施:培训,技术援助(TA),工具,和资源。所有医疗中心都实施了在产前,分娩和分娩期之间提供护理的选项B指南。在社区活动期间和分娩后护理期间,选项B+的实施出现了差距,包括在6周时对儿童进行检测以确定其艾滋病毒状况的差距,12个月,还有24个月.突出的环境因素包括人员短缺,交通挑战,有限的空间和基础设施,艾滋病毒检测试剂盒的库存有限,和大量患者。
结论:了解影响实施支持策略和交付选项B+指南的因素,例如工作人员和其他材料/药物资源的可用性,对于为低资源设置设计有效的实施支持至关重要。
BACKGROUND: High HIV infection and fertility rates contributed to over 12,000 children acquiring HIV from their mothers in 2011 in Malawi. To prevent mother-to-child transmission of HIV, Malawi adopted the Option B+
guidelines, and for three years, the University of North Carolina (UNC) Project provided support to strengthen
guideline implementation in 134 health centres. Little is known about how implementation support strategies are delivered in low resource countries or contextual factors that may influence their delivery. The limited descriptions of support strategies and salient contextual factors limits efforts to replicate, target, and further refine strategies. Guided by the Interactive Systems Framework for Dissemination and Implementation, this study describes factors influencing implementation of support strategies and how they impacted health center staff capacity to implement Option B+ in Malawi.
METHODS: A
qualitative multi-case study design was applied. Data were collected through site visits to 4 heath centres (2 low- and 2-high performing centres). We interviewed 18 support providers and recipients between October 2014 and October 2015. Data were analysed using content, thematic, and cross-case analysis.
RESULTS: Four categories of strategies were used to support Option B+
guidelines implementation: training, technical assistance (TA), tools, and resources. All heath-centres implemented Option B+
guidelines for care provided between the antenatal and labor and delivery periods. Gaps in Option B+ implementation occurred during community activities and during post-delivery care, including gaps in testing of children to ascertain their HIV status at 6 weeks, 12 months, and 24 months. Salient contextual factors included staffing shortages, transportation challenges, limited space and infrastructure, limited stocks of HIV testing kits, and large patient populations.
CONCLUSIONS: Understanding factors that influence implementation support strategies and delivery of the Option B+ guidelines, such as availability of staff and other materials/drug resources, is critical to designing effective implementation support for low resource settings.