A comprehensive review of the barriers and promoters health workers experience in delivering prevention of vertical transmission of HIV services in sub-Saharan Africa

Datos Bibliográficos

ID19444496
AutoresRoseanne C Schuster (0000-0002-3747-5267, ,, autor de correspondencia), Devon E McMahon (0000-0002-3649-9208, ,), Sera Lewise Young (0000-0002-1763-1218, Cornell University)
Año2016
Volumen28
Número6
Páginas778-794
Fecha de publicación2016-06-02
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaAIDS Care (JOURNAL)
Identificadores de la revistaISSN: 0954-0121 • E-ISSN: 1360-0451
EditorialInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2016.1139041
PMID26883903
OpenAlexW2276153134
IdiomaEN
Citas recibidas4
Referencias citadas73

Despite significant biomedical and policy advances, 199,000 infants and young children in sub-Saharan Africa (SSA) became infected with HIV in 2013, indicating challenges to implementation of these advances. To understand the nature of these challenges, we sought to (1) characterize the barriers and facilitators that health workers encountered delivering prevention of vertical transmission of HIV (PVT) services in SSA and (2) evaluate the use of theory to guide PVT service delivery. The PubMed and CINAHL databases were searched using keywords barriers, facilitators, HIV, prevention of vertical transmission of HIV, health workers, and their synonyms to identify relevant studies. Barriers and facilitators were coded at ecological levels according to the Determinants of Performance framework. Factors in this framework were then classified as affecting motivation, opportunity, or ability, per the Motivation-Opportunity-Ability (MOA) framework in order to evaluate domains of health worker performance within each ecological level. We found that the most frequently reported challenges occurred within the health facility level and spanned all three MOA domains. Barriers reported in 30% or more of studies from most proximal to distal included those affecting health worker motivation (stress, burnout, depression), patient opportunity (stigma), work opportunity (poor referral systems), health facility opportunity (overburdened workload, lack of supplies), and health facility ability (inadequate PVT training, inconsistent breastfeeding messages). Facilitators were reported in lower frequencies than barriers and tended to be resolutions to challenges (e.g., quality supervision, consistent supplies) or responses to an intervention (e.g., record systems and infrastructure improvements). The majority of studies did not use theory to guide study design or implementation. Interventions addressing health workers' multiple ecological levels of interactions, particularly the health facility, hold promise for far-reaching impact as distal factors influence more proximal factors. Incorporating theory that considers factors beyond the health worker will strengthen endeavors to mitigate barriers to PVT service delivery

Breastfeeding · Burnout · Business · CINAHL · Environmental health · Psychiatry · Psychological intervention · Referral · Service delivery framework · Workload · Adolescent Sexual and Reproductive Health · Clinical Psychology · Global Maternal and Child Health · HIV/AIDS Research and Interventions · Medicine · Nursing · Marketing · Pediatrics