Barcelona 2013
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| Abstract #623 - E-Posters English | ||||
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Session: 50.131: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Miss Annabelle Gourlay - London School of Hygiene and Tropical Medicine, United Kingdom |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: Interactions between patients and service providers have been shown to affect uptake of prevention of mother-to-child transmission (PMTCT) of HIV services in sub-Saharan Africa. However, the nature and role of patient-provider interactions in the context of PMTCT are rarely reported in depth. This study explored how the relationship between patients and providers influenced the uptake of PMTCT services in government health facilities in rural Tanzania. | ||||
| Method / Issue: A qualitative study was conducted in 2012 in Kisesa, north-west Tanzania. Participatory group activities were held with 3 male and 3 female groups of community members. In-depth interviews were conducted with 16 HIV-positive and 5 HIV-negative mothers, 3 partners/ relatives of HIV-positive mothers, and 9 health workers and officials. Observations were made in Kisesa antenatal and child clinics. Data were transcribed, translated (into English) and analysed (using a thematic approach) with the aid of NVIVO 9 software. A theoretical model of patient-centred care was adapted and used to organise themes. | ||||
| Results / Comments: Respectful care was a major theme. Participants often described reasonable treatment by clinic staff, and occasionally portrayed kind or compassionate staff. Interviews with nurses also revealed cases of empathetic conduct. However many women gave accounts of disrespectful staff behaviour including scolding, and discrimination or stigmatisation of HIV-positive patients. These were common during delivery, affecting both HIV-positive and negative women. Lack of supplies (gloves, sheets) at the facilities, and costs for providing items, frustrated staff and exacerbated disrespectful care. Negative experiences of staff behaviour during pregnancy, or fears of scolding (eg. for failing to take antiretroviral prophylaxis), influenced adherence to subsequent steps of the PMTCT programme such as infant prophylaxis. Shared decision-making also emerged as important. For example, effective communication in counselling sessions or routine appointments contributed to patient understanding and encouraged women to return to the clinic or take drugs. Illustrations of poor communication and power imbalance were also evident: some patients reported not receiving information (eg. HIV test results), but did not question their provider, thus missing opportunities to receive key services. Counselling advice was sometimes unclear or insufficient, and omission of pre-HIV test counselling was often described or observed. This influenced patient knowledge, and raised ethical concerns, since many women believed they could not opt-out of the HIV test. Continuity of care was a less common theme, but affected adherence to the PMTCT programme: trust in and familiarity with a provider could motivate HIV-positive women to return to the facility, while some were reluctant to be transferred into the care of other providers. | ||||
| Discussion: The patient-provider relationship plays a pivotal role in HIV-positive pregnant women's access to and retention in PMTCT care services. Strategies to avoid the negative consequences of poor patient-provider interactions should focus on improving staff behaviour (including adherence to the ethics of care) and communication, while empowering patients to seek information about the services they need. Optimising relations between providers and patients in the context of maternal health care could also improve uptake of services, including skilled delivery, for all pregnant women regardless of HIV status. | ||||
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