The role of trust and health literacy in nurse-delivered point-of-care STI testing for pregnant women living with HIV, Tshwane District, South Africa.
Adult
Female
HIV Infections
/ nursing
Health Literacy
Humans
Infectious Disease Transmission, Vertical
/ prevention & control
Nurse-Patient Relations
Patient Acceptance of Health Care
/ psychology
Point-of-Care Testing
Pregnancy
Pregnancy Complications, Infectious
/ diagnosis
Pregnant Women
/ psychology
Prenatal Diagnosis
/ methods
Sexually Transmitted Diseases
/ diagnosis
South Africa
Trust
HIV
Patient-provider communications
Point-of-care testing
Pregnancy
Sexually transmitted infections
South Africa
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
28 Apr 2020
28 Apr 2020
Historique:
received:
29
11
2019
accepted:
13
04
2020
entrez:
30
4
2020
pubmed:
30
4
2020
medline:
2
10
2020
Statut:
epublish
Résumé
Sexually transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. Yet the World Health Organization's current syndromic management guidelines for STIs leaves most pregnant women undiagnosed and untreated. Point-of-care (POC) diagnostic tests for STIs can drastically improve detection and treatment. Though acceptable and feasible, poor medication adherence and re-infection due to lack of partner treatment threaten the programmatic effectiveness of POC diagnostic programmes. To engender patient-provider trust, and improve medication adherence and disclosure of STI status to sexual partners, we trained study nurses in compassionate care, good clinical practices and motivational interviewing. Using qualitative methods, we explored the role patient-provider communications may play in supporting treatment adherence and STI disclosure to sexual partners. Nurses were provided training in motivational interviewing, compassionate care and good clinical practices. Participants were interviewed using a semi-structured protocol, with domains including STI testing experience, patient-provider communication, and HIV and STI disclosure. Interviews were audio-recorded, transcribed and analyzed using a constant comparison approach. Twenty-eight participants treated for Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and/or Neisseria gonorrhea (NG) were interviewed. Participants described strong communications and trusting relationships with nurses trained in patient-centered care training and implementing POC STI diagnostic testing. However, women described a delayed trust in treatment until their symptoms resolved. Women expressed a limited recall of their exact diagnosis, which impacted their ability to fully disclose their STI status to sexual partners. We recommend implementing patient health literacy programmes as part of POC services to support women in remembering and disclosing their specific STI diagnosis to sexual partners, which may facilitate partner treatment uptake and thus decrease the risk of re-infection.
Sections du résumé
BACKGROUND
BACKGROUND
Sexually transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. Yet the World Health Organization's current syndromic management guidelines for STIs leaves most pregnant women undiagnosed and untreated. Point-of-care (POC) diagnostic tests for STIs can drastically improve detection and treatment. Though acceptable and feasible, poor medication adherence and re-infection due to lack of partner treatment threaten the programmatic effectiveness of POC diagnostic programmes.
METHODS
METHODS
To engender patient-provider trust, and improve medication adherence and disclosure of STI status to sexual partners, we trained study nurses in compassionate care, good clinical practices and motivational interviewing. Using qualitative methods, we explored the role patient-provider communications may play in supporting treatment adherence and STI disclosure to sexual partners. Nurses were provided training in motivational interviewing, compassionate care and good clinical practices. Participants were interviewed using a semi-structured protocol, with domains including STI testing experience, patient-provider communication, and HIV and STI disclosure. Interviews were audio-recorded, transcribed and analyzed using a constant comparison approach.
RESULTS
RESULTS
Twenty-eight participants treated for Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and/or Neisseria gonorrhea (NG) were interviewed. Participants described strong communications and trusting relationships with nurses trained in patient-centered care training and implementing POC STI diagnostic testing. However, women described a delayed trust in treatment until their symptoms resolved. Women expressed a limited recall of their exact diagnosis, which impacted their ability to fully disclose their STI status to sexual partners.
CONCLUSIONS
CONCLUSIONS
We recommend implementing patient health literacy programmes as part of POC services to support women in remembering and disclosing their specific STI diagnosis to sexual partners, which may facilitate partner treatment uptake and thus decrease the risk of re-infection.
Identifiants
pubmed: 32345293
doi: 10.1186/s12889-020-08689-3
pii: 10.1186/s12889-020-08689-3
pmc: PMC7189538
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
577Subventions
Organisme : NICHD NIH HHS
ID : R21 HD084274
Pays : United States
Organisme : Eunice Kennedy Shriver National Institute of Child Health and Human Development
ID : R21HD084274-01A1
Références
Sex Transm Dis. 2009 Aug;36(8):478-89
pubmed: 19617871
Cogn Behav Pract. 2014 May;21(2):191-205
pubmed: 25452680
J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):437-42
pubmed: 22046601
J Nurs Scholarsh. 2004;36(2):161-6
pubmed: 15227764
J Assoc Nurses AIDS Care. 2016 Sep-Oct;27(5):574-84
pubmed: 27080926
Front Public Health. 2017 Jul 31;5:188
pubmed: 28824897
SAHARA J. 2013;10(2):105-12
pubmed: 24405286
AIDS Patient Care STDS. 2016 Feb;30(2):70-7
pubmed: 26784360
Sex Transm Dis. 2018 Nov;45(11):754-761
pubmed: 30303949
Implement Sci. 2012 Jul 16;7:66
pubmed: 22800379
BMC Health Serv Res. 2018 May 11;18(1):363
pubmed: 29751798
AIDS Care. 2012;24(6):680-6
pubmed: 22103696
Int J STD AIDS. 1999 Jul;10(7):452-9
pubmed: 10454180
PLoS One. 2013 Aug 26;8(8):e66593
pubmed: 23990868
BMC Public Health. 2011 Oct 10;11:778
pubmed: 21985332
Sex Health. 2019 Jun;16(3):274-281
pubmed: 31072453
Int J STD AIDS. 2018 Mar;29(4):324-333
pubmed: 28799824
PLoS One. 2017 May 1;12(5):e0176256
pubmed: 28459866
J Int Assoc Physicians AIDS Care (Chic). 2012 Mar-Apr;11(2):128-33
pubmed: 22361449
AIDS Care. 2012;24(12):1480-6
pubmed: 22530855
AIDS Care. 1990;2(3):247-52
pubmed: 2088520
Reprod Health. 2017 Aug 14;14(1):95
pubmed: 28806985
Patient Prefer Adherence. 2018 May 24;12:919-927
pubmed: 29872277
Int J STD AIDS. 2020 Mar;31(4):294-302
pubmed: 32089090
Sex Transm Infect. 2015 May;91(3):207-13
pubmed: 25298381
Infect Dis Obstet Gynecol. 2018 May 9;2018:3946862
pubmed: 29861622
PLoS One. 2014 Jun 02;9(6):e98389
pubmed: 24887260
AIDS Patient Care STDS. 2018 Nov;32(11):477-486
pubmed: 30398953
BMC Public Health. 2007 Feb 01;7:18
pubmed: 17270044
Clin Infect Dis. 2008 Apr 1;46(7):994-9
pubmed: 18444815
PLoS One. 2017 Jan 3;12(1):e0169388
pubmed: 28046104
Sex Transm Dis. 2015 Oct;42(10):554-65
pubmed: 26372927
Curr HIV/AIDS Rep. 2013 Dec;10(4):295-304
pubmed: 24222474
PLoS One. 2018 Jul 2;13(7):e0199977
pubmed: 29965990
Point Care. 2019 Mar;18(1):17-25
pubmed: 30886544
J Assoc Nurses AIDS Care. 2017 May - Jun;28(3):408-421
pubmed: 28279587
Biomed Res Int. 2016;2016:9315757
pubmed: 27144177
AIDS. 2001 Jun 15;15(9):1157-65
pubmed: 11416718
J Assoc Nurses AIDS Care. 2018 Mar - Apr;29(2):190-203
pubmed: 29248420
Nurs Ethics. 2013 Aug;20(5):501-16
pubmed: 23426234