To get him to come. (Female maternal and child SCIO-469 biological activity health nurse, 43 years old, Maputo Province) What is difficult is finding men to pass on the message . . . If we went to see the organizations that are working in this area, . . . most participants are women, but at the same time we discovered that even though the woman has the information, she still does not have the power, even if the husband has the information, we need to work with men to change this. (Female program manager, 33 years old, Sofala Province) A second type of barrier discussed by providers related to the clinic environment. These structural barriers included high patient load, time constraints, frequent staff turnover and not enough staff, and supply chain logistics issues (e.g. condom stock-outs). The facilities are not appropriate. The time factor. Joint offices for consultations. For example, five minutes to talk to an HIV-positive patient is not enough. . . . we end up rushing it. (Male medical technician, 47 years old, Maputo Province) . . . In general, maybe the lack of staff [hinders Positive Prevention], . . . because sometimes the flow of patients into this area needs a person . . . I think that I needed a permanent person, . . . but sometimes the people [the healthcareproviders] themselves are moved so abruptly, there is not enough staff for other activities. (Female Maternal and Child Health Nurse, 43 years old, Maputo Province) . . . the condoms sometimes end up running out so sometimes patients arrive at the clinic in need of condoms and they hear that there are none, and how they wanted to do something that day, they may go do it like that and do it without a condom because there are none. (Male counselor, 39 years ?old, Zambezia Province) While these issues were troubling to providers, they were secondary to the many social and cultural barriers that providers described. Providers voiced many barriers that PLHIV face when trying to make safer sexual choices, but had few strategies for addressing the social and cultural challenges they described.4.DiscussionIn this study, PP messages and interventions were reported to be useful, relevant, acceptable and feasible for Mozambican healthcare providers. Providers also showed more comfort in counseling their patients about prevention and using a holistic approach that includes HIV partner Olmutinib cost testing, treatment and positive living. As a result of the training, providers were able to implement this new approach with their patients. This included the ability to implement or discuss several of the practices learned during the PP training, such as risk assessment, risk reduction counseling, reduction in the number of sexual partners, adherence to treatment, PMTCT and the importance of positive living. Much like our results from Mozambique, US-based PP interventions have been feasible and acceptable to implement (Fisher et al. 2006; Richardson et al. 2004; Thrun et al. 2009). Thrun and colleagues in the USA have found that their Positive Steps training, a PP intervention for providers, led to positive changes in attitudes, comfort, self-efficacy, and frequency in discussing prevention issues (Thrun et al. 2009). Another study in the USA concluded that interventions that are well matched to the clinical environment and patient population being served were feasible and acceptable to healthcare providers, prevention interventionists and clinic staff (Koester, Maiorana, Morin, Rose, Shade Myers 2012). Fewer studies in Africa.To get him to come. (Female maternal and child health nurse, 43 years old, Maputo Province) What is difficult is finding men to pass on the message . . . If we went to see the organizations that are working in this area, . . . most participants are women, but at the same time we discovered that even though the woman has the information, she still does not have the power, even if the husband has the information, we need to work with men to change this. (Female program manager, 33 years old, Sofala Province) A second type of barrier discussed by providers related to the clinic environment. These structural barriers included high patient load, time constraints, frequent staff turnover and not enough staff, and supply chain logistics issues (e.g. condom stock-outs). The facilities are not appropriate. The time factor. Joint offices for consultations. For example, five minutes to talk to an HIV-positive patient is not enough. . . . we end up rushing it. (Male medical technician, 47 years old, Maputo Province) . . . In general, maybe the lack of staff [hinders Positive Prevention], . . . because sometimes the flow of patients into this area needs a person . . . I think that I needed a permanent person, . . . but sometimes the people [the healthcareproviders] themselves are moved so abruptly, there is not enough staff for other activities. (Female Maternal and Child Health Nurse, 43 years old, Maputo Province) . . . the condoms sometimes end up running out so sometimes patients arrive at the clinic in need of condoms and they hear that there are none, and how they wanted to do something that day, they may go do it like that and do it without a condom because there are none. (Male counselor, 39 years ?old, Zambezia Province) While these issues were troubling to providers, they were secondary to the many social and cultural barriers that providers described. Providers voiced many barriers that PLHIV face when trying to make safer sexual choices, but had few strategies for addressing the social and cultural challenges they described.4.DiscussionIn this study, PP messages and interventions were reported to be useful, relevant, acceptable and feasible for Mozambican healthcare providers. Providers also showed more comfort in counseling their patients about prevention and using a holistic approach that includes HIV partner testing, treatment and positive living. As a result of the training, providers were able to implement this new approach with their patients. This included the ability to implement or discuss several of the practices learned during the PP training, such as risk assessment, risk reduction counseling, reduction in the number of sexual partners, adherence to treatment, PMTCT and the importance of positive living. Much like our results from Mozambique, US-based PP interventions have been feasible and acceptable to implement (Fisher et al. 2006; Richardson et al. 2004; Thrun et al. 2009). Thrun and colleagues in the USA have found that their Positive Steps training, a PP intervention for providers, led to positive changes in attitudes, comfort, self-efficacy, and frequency in discussing prevention issues (Thrun et al. 2009). Another study in the USA concluded that interventions that are well matched to the clinical environment and patient population being served were feasible and acceptable to healthcare providers, prevention interventionists and clinic staff (Koester, Maiorana, Morin, Rose, Shade Myers 2012). Fewer studies in Africa.
