Skip to main content

Table 2 Enabling and hindering factors in the implementation of syphilis and HIV POC screening among the indigenous people in the Alto Solimões DSEI

From: Point-of-care screening for syphilis and HIV in the borderlands: challenges in implementation in the Brazilian Amazon

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
  1. CHW community health worker, DSEI Special Indigenous Health District, FUAM Fundação Alfredo da Matta, IEC information, education, and communication