Kamanga G, Brown L, Jawati P, Chiwanda D, Nyirenda N
UNC Project-Malawi, Lilongwe, Malawi.
Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
Malawi Med J. 2015 Dec;27(4):140-4.
HIV testing and counselling (HTC) is important to effect positive sexual behaviour change and is an entry point to treatment, care, and psychosocial support. One of the most practical initiatives to increase HTC is to encourage sexual partners of HIV-infected persons to test for HIV. However, partner notification strategies must be feasible in the healthcare setting and acceptable to the population.
We conducted a qualitative study during the pilot phase of an HIV partner notification trial to complement its assessment of feasibility and acceptability of methods of partner notification. We performed in-depth interviews with 16 consecutive HIV-positive index participants who consented and their 12 identifiable sexual partners. We also conducted two focus group discussions with healthcare workers to supplement the patient perspectives. In the main study, newly diagnosed HIV cases (index cases) were randomized to one of three methods of partner notification: passive, contract, and provider referral. Clients in the passive referral group were responsible for notifying their sexual partners themselves. Individuals in the contract referral group were given seven days to notify their partners, after which a healthcare provider contacted partners who had not reported for counselling and testing. In the provider group, a healthcare provider notified partners directly.
Although most index participants and partners expressed a preference for passive notification, they also highlighted benefits for provider-assisted notification and the universal right for all HIV-exposed persons to know their HIV exposure and benefit from HIV testing and access antiretroviral treatment. Several participants mentioned couples counselling as a way to diffuse tension and get accurate information. All mentioned benefits to HIV testing, including the opportunity to change behaviour.
Provider-assisted partner notification is not preferred, but it is acceptable and may complement the passive method of notification. Couples counselling should also be encouraged.
艾滋病毒检测与咨询对于促使性行为发生积极改变至关重要，并且是治疗、护理及心理社会支持的切入点。增加艾滋病毒检测与咨询的最切实可行的举措之一是鼓励艾滋病毒感染者的性伴侣进行艾滋病毒检测。然而，性伴侣通知策略在医疗环境中必须可行且为民众所接受。
在一项艾滋病毒性伴侣通知试验的试点阶段，我们开展了一项定性研究，以补充对性伴侣通知方法的可行性和可接受性的评估。我们对16名连续同意参与的艾滋病毒阳性索引参与者及其12名可识别的性伴侣进行了深入访谈。我们还与医护人员进行了两次焦点小组讨论，以补充患者的观点。在主要研究中，新诊断出的艾滋病毒病例（索引病例）被随机分配到三种性伴侣通知方法之一：被动通知、契约通知和提供者转介。被动转介组的客户负责自行通知其性伴侣。契约转介组的个人有七天时间通知其伴侣，之后医护人员会联系未前来咨询和检测的伴侣。在提供者组中，医护人员直接通知伴侣。
尽管大多数索引参与者和伴侣表示倾向于被动通知，但他们也强调了提供者协助通知的好处，以及所有艾滋病毒暴露者了解自己艾滋病毒暴露情况并从艾滋病毒检测和获得抗逆转录病毒治疗中受益的普遍权利。几名参与者提到夫妻咨询是缓解紧张情绪并获取准确信息的一种方式。所有人都提到了艾滋病毒检测的好处，包括改变行为的机会。
提供者协助的性伴侣通知并非首选，但它是可以接受的，并且可以补充被动通知方法。还应鼓励夫妻咨询。
