Goyette Marielle, Wamuti Beatrice Muthoni, Owuor Mercy, Bukusi David, Maingi Peter Mutiti, Otieno Felix Abuna, Cherutich Peter, Ng'ang'a Anne, Farquhar Carey
1 Department of Epidemiology, University of Washington , Seattle, Washington.
2 Department of Research and Programs, Kenyatta National Hospital , Nairobi, Kenya .
AIDS Patient Care STDS. 2016 Nov;30(11):506-511. doi: 10.1089/apc.2016.0151.
Assisted partner services (APS) are more effective than passive referral in identifying new cases of HIV in many settings. Understanding the barriers to the uptake of APS in sub-Saharan Africa is important before its scale up. In this qualitative study, we explored client, community, and healthcare worker barriers to APS within a cluster randomized trial of APS in Kenya. We conducted 20 in-depth interviews with clients who declined enrollment in the APS study and 9 focus group discussions with health advisors, HIV testing and counseling (HTC) counselors, and the general HTC client population. Two analysts coded the data using an open coding approach and identified major themes and subthemes. Many participants reported needing more time to process an HIV-positive result before providing partner information. Lack of trust in the HTC counselor led many to fear a breach of confidentiality, which exacerbated the fears of stigma in the community and relationship conflicts. The type of relationship affected the decision to provide partner information, and the lack of understanding of APS at the community level contributed to the discomfort in enrolling in the study. Establishing trust between the client and HTC counselor may increase uptake of APS in Kenya. A client's decision to provide partner information may depend on the type of relationship he or she is in, and alternative methods of disclosure may need to be offered to accommodate different contexts. Spreading awareness about APS in the community may make clients more comfortable providing partner information.
在许多情况下,辅助性伴侣服务(APS)在识别新的艾滋病毒病例方面比被动转介更有效。在扩大APS规模之前,了解撒哈拉以南非洲地区采用该服务的障碍很重要。在这项定性研究中,我们在肯尼亚的一项APS整群随机试验中,探讨了客户、社区和医护人员对APS的障碍。我们对拒绝参加APS研究的客户进行了20次深入访谈,并与健康顾问、艾滋病毒检测与咨询(HTC)顾问以及一般HTC客户群体进行了9次焦点小组讨论。两名分析师采用开放编码方法对数据进行编码,并确定了主要主题和子主题。许多参与者报告说,在提供伴侣信息之前,需要更多时间来处理艾滋病毒检测呈阳性的结果。对HTC顾问缺乏信任导致许多人担心保密性被泄露,这加剧了他们对社区耻辱感和关系冲突的恐惧。关系类型影响了提供伴侣信息的决定,社区层面缺乏对APS的了解导致参与研究时感到不适。在肯尼亚,建立客户与HTC顾问之间的信任可能会增加对APS的采用率。客户提供伴侣信息的决定可能取决于他或她所处的关系类型,可能需要提供其他披露方式以适应不同情况。在社区传播关于APS的认识可能会使客户在提供伴侣信息时更加自在。
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