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

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