Integrating safer conception services into primary care: providers’ perspectives

BMC Public Health

Annelies Van Rie¹  Leah Holmes²  Sheree R. Schwartz²  Mariya C. Patwa²  Thembisile Makhomboti³  Jean Bassett³  Mutsa Mudavanhu³  Lillian Mutunga³ 

[1] Department of Epidemiology and Social Medicine, University of Antwerp, Antwerpen, Belgium;Johns Hopkins Bloomber School of Public Health, 615 N Wolfe St. E7136, Baltimore, MD, USA;Witkoppen Health and Welfare Centre, Johannesburg, South Africa;

关键词: Afer conception;    Service integration;    HIV;    Family planning;    HIV prevention;   

DOI  :  10.1186/s12889-019-6904-0

来源: Springer

【 摘 要 】

BackgroundIn 2012, South Africa adopted the Contraception and Fertility Planning guidelines to incorporate safer conception services into care for HIV-affected couples trying to conceive. These guidelines lacked clear implementation and training recommendations. The objective of this study was to investigate factors influencing integration of safer conception services in a clinical setting.MethodsTwenty in-depth interviews were conducted between October–November 2017 with providers and staff at Witkoppen Clinic in Johannesburg, where the Sakh’umndeni safer conception demonstration project had enrolled patients from July 2013–July 2017. Semi-structured interview guides engaged providers on their perspectives following the Sakh’umndeni project and possible integration plans to inform the translation of the stand-alone Sakh’umndeni services into a routine service. A grounded theory approach was used to code interviews and an adaptation of the Atun et al. (2010) ‘Integration of Targeted Interventions into Health Systems’ conceptual framework was applied as an analysis tool.ResultsFive themes emerged: (1) The need for safer conception training; (2) The importance of messaging and demand generation; (3) A spectrum of views around the extent of integration of safer conception services; (4) Limitations of family planning services as an integration focal point; and (5) Benefits and challenges of a “couples-based” intervention. In-depth interviews suggested that counselors, as the first point of contact, should inform patients about safer conceptions services, followed by targeted reinforcement of safer conception messaging by all clinicians, and referral to more intensively trained safer conception providers.ConclusionA safer conception counseling guide would facilitate consultations. While many providers felt that the services belonged in family planning, lack of HIV management skills, men and women trying to conceive within family planning may pose barriers.

【 授权许可】

CC BY