采用咨询师支持的披露模式以提高肯尼亚夫妇艾滋病毒检测与咨询的接受率：一项准实验研究。

Use of a counsellor supported disclosure model to improve the uptake of couple HIV testing and counselling in Kenya: a quasi-experimental study.

作者信息

Kababu Margaret, Sakwa Eric, Karuga Robinson, Ikahu Annrita, Njeri Inviolata, Kyongo Jordan, Khamali Catherine, Mukoma Wanjiru

机构信息

LVCT Health, Nairobi, Kenya.

Root capital, Nairobi, Kenya.

出版信息

BMC Public Health. 2018 May 18;18(1):638. doi: 10.1186/s12889-018-5495-5.

DOI:10.1186/s12889-018-5495-5

PMID:29776410

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5960164/

Abstract

BACKGROUND

Heterosexual couples account for 44% of new HIV infections in Kenya and there's low awareness of self and partner HIV status. Different strategies have been employed to promote couple HIV testing and counselling (CHTC). Despite this, HIV incidence among couples continues to rise. This study sought to assess the use of a counsellor-supported disclosure (CSD) model in enhancing the uptake of CHTC and the factors that were associated with it.

METHODS

A pre-post quasi experimental study design with an intervention and a comparison arm was utilized. The study was conducted in Nairobi, Nakuru, Kisumu, and Homa Bay counties in Kenya. A total of 276 participants were recruited; 149 and 127 in the comparison and intervention arms, respectively. Standard HIV testing & counselling (HTC) was offered in the comparison arm whereas the counsellor-supported disclosure model was administered in the intervention arm. The model empowered index clients to invite their sexual partner for CHTC. Telephone follow-up and subsequent community health volunteer (CHV) follow-up for non-responders were embedded in the model. Semi-structured questionnaires were used to collect data at baseline and 3 months into the study. In-depth interviews were conducted with 15 participants who took up the intervention and 7 of the HTC providers who offered CSD. The quantitative and qualitative data were analyzed using STATA version 13 and NVIVO 10, respectively.

RESULTS

Uptake of CHTC was 28% in the intervention arm of the study compared to 7% in the comparison arm (p < 0.001). Participants in the intervention arm of the study had eight times higher odds of taking up CHTC compared to their counterparts. The outcome of the qualitative interviews revealed that the CSD counselling, skills on partner invitation, and follow-up for partner invitation increased the uptake of CHTC. On the other hand, unwillingness to test together with partner, lack of availability to test together as a couple, and provision of the wrong contact information by the participants reduced the uptake of CHTC.

CONCLUSION

The CSD model improved the uptake of CHTC. This model can be integrated into the existing HTC structures to enhance the uptake of CHTC.

摘要

背景

异性恋伴侣占肯尼亚新增艾滋病毒感染病例的44%，人们对自身及伴侣的艾滋病毒感染状况知晓率较低。为促进伴侣艾滋病毒检测与咨询（CHTC），已采用了不同策略。尽管如此，伴侣间的艾滋病毒感染率仍在持续上升。本研究旨在评估使用咨询师支持的披露（CSD）模式来提高CHTC的接受率以及与之相关的因素。

方法

采用前后对照的准实验研究设计，设有干预组和对照组。研究在肯尼亚的内罗毕、纳库鲁、基苏木和霍马湾县开展。共招募了276名参与者；对照组和干预组分别有149名和127名。对照组提供标准的艾滋病毒检测与咨询（HTC），而干预组采用咨询师支持的披露模式。该模式使指标客户有能力邀请其性伴侣接受CHTC。该模式还包括电话随访以及随后对无回应者的社区卫生志愿者（CHV）随访。在基线和研究进行3个月时，使用半结构化问卷收集数据。对15名接受干预的参与者和7名提供CSD的HTC服务提供者进行了深入访谈。分别使用STATA 13版和NVIVO 10对定量和定性数据进行分析。

结果

研究干预组的CHTC接受率为28%，而对照组为7%（p < 0.001）。研究干预组的参与者接受CHTC的几率是对照组参与者的8倍。定性访谈结果显示，CSD咨询、邀请伴侣的技巧以及对伴侣邀请的随访提高了CHTC的接受率。另一方面，不愿意与伴侣一起检测、无法作为伴侣共同检测以及参与者提供错误的联系信息降低了CHTC的接受率。