Table 2 Enabling and hindering factors in the implementation of syphilis and HIV POC screening among the indigenous people in the Alto Solimões DSEI
Main categories | Enabling factors | Hindering factors |
|---|---|---|
Preparation | - Collaboration of the main actors and well-defined roles and responsibilities - Reliable supply chain (FUAM) - Organised transport to the field - Planning of screening activities with the collaboration of CHWs and consideration of other scheduled work at the polo base | - Absenteeism of health professionals due to full schedule of health activities and interventions in the DSEI - Insufficient supply of drugs and consumables - Logistics at DSEI head office in Tabatinga (shortage of gasoline) and transportation logistics of FUNASA Manaus |
Promotion of screening activities in the indigenous population | - Strategies to promote activities in indigenous communities include: - Contact: CHWs, village leaders, teachers - Population: area of 1 CHW - Sites: polo bases, indigenous communities - Topics: health education, screening activities - Translators: CHWs, teachers | - Lack of IEC material |
Testing | - Availability of rapid testing assured - Technical functionality of rapid testing used for the present screening - Organisation of the cold chain during field visits (e.g., combined with vaccination) | - Insufficient number of trained health professionals - Incorrect handling of rapid testing (fingerprick) - Insufficient understanding of the necessity of syphilis testing - Acceptance of rapid testing in indigenous communities limited because of anxiety about the pain of testing and possibility of a positive result |
Counselling | - Guarantee of the accuracy of the translators collaborating with the skilled health professionals and CHWs - Guarantee of patient confidentiality - Inclusion of translations and patient confidentiality in the preparation meetings and trainings for the polo base team - Consistent partner notification | - Language not adapted to the indigenous population - Incomplete and incoherent information during counselling - Insufficient patient understanding of the importance of being tested for syphilis - Insufficient ability to address patient anxiety - Lack of respect for patient confidentiality - Lack of privacy during counselling |
Follow-up | - Organisation of medication administration (1st dose immediately after test; CHW must schedule and bring patient to a polo base for 2nd and 3rd doses) - Organisation of follow-up in the DSEI | - Insufficient stock of benzathine benzylpenicillin |
Health information system | - Monitoring sheet clear and easy to handle - Data processing performed by epidemiology team at FUAM | - Compulsory notification not completed - Delayed collection of the monitoring data (FUNASA transportation logistics) |
Training of the HP on the screening activities (FUAM) | - Collection of required data regarding the study site (DSEI, health professionals) and screening population - Efficient organisation of the training (identification of the number of health professionals to be trained and organisation of the infrastructure) - Development of hand-outs and materials regarding the performance of screening using rapid testing in the field | - Inappropriate language for indigenous people (too technical) - Inappropriate hand-outs - Practical part not adapted to field conditions (only applicable to laboratory conditions) - No uniformity in the training curriculum (various trainers) - Technical and counselling contents are inconsistent - No consideration given to the suggestions of the health professionals regarding the adaptation and improvement of training (assessment of the training) - Insufficient focus on problems related to the communication of a positive test result |