Oluoch P, Achia T, Mutinda D, Orwa J, Oundo J, Karama M, Ng'ang'a Z
Division of Global HIV/AIDS & TB (DGHT), US Centers for Disease Control and Prevention (CDC), Kenya and Institute of Tropical Medicine and Infectious Diseases (ITROMID).
Kenya Medical Research Institute (KEMRI), Kenya.
Afr J Health Sci. 2017 Mar-Apr;30(2):139-158.
BACKGROUND: Home based HIV testing and counseling (HBTC) increases access to services and is associated with high testing uptake. Alongside testing, individuals are offered HIV prevention messages with an aim of helping them reduce HIV high risk sexual behaviors. This study explored the level of provision and subsequent utilization of HIV prevention messages and associated change in behavior among individuals who had received HBTC previously in an informal settlement. METHODS: In a mixed method cross sectional study, we interviewed 1257 individuals and conducted 6 focus group discussions (FGD). Multiple correspondence analysis (MCA) was used to construct provision of prevention messages and behavior change indices using STATA 3.0. Pearson's chi-square statistics was used to test for bivariate association between the outcomes and logistic regression analysis was carried out with the behavior change index as the outcome of interest and the predictors considered significant (p<0.1). Thematic content analysis for qualitative data was done using Atlas 3.0. RESULTS: Out of the 1257participants, 1078 (85.8%) had ever tested for HIV, with 74.2% having tested in the Kibera HBTC program. Nearly all (97.4%) rated HBTC experience as either excellent (62.4%) or good (37%) and would recommend it to a friend. Provision of prevention messages was high among HBTC clients compared to clients from other testing sites; partner reduction counselling (64% versus 52%) and faithfulness (78.3% versus 67%); p=0.001. Self-reported behavior change after HBTC was generally low with condom use at 10.7% and men more likely to practice safer sex (p = 0.002). Trust of the sexual partners and fear of suspicion were the main reasons given for not using condoms. Clients testing HIV positive after previous negative result were 3.4%. The focus group discussions reported multiple sexual partnerships among both HIV negative and positive residents alike. CONCLUSION: Although prevention messages delivered during HBTC are accepted and appreciated in this community, their utilization is low in both HIV negative and positive individuals. Innovative strategies for change of normative beliefs about sexual behavior are urgently needed.
背景：基于家庭的艾滋病毒检测与咨询（HBTC）增加了服务的可及性，并与高检测接受率相关。除检测外，还向个人提供艾滋病毒预防信息，旨在帮助他们减少艾滋病毒高风险性行为。本研究探讨了艾滋病毒预防信息的提供水平及其后续利用情况，以及曾在非正式定居点接受过HBTC的个人行为的相关变化。 方法：在一项混合方法横断面研究中，我们对1257人进行了访谈，并开展了6次焦点小组讨论（FGD）。使用STATA 3.0通过多重对应分析（MCA）构建预防信息提供和行为改变指数。使用Pearson卡方统计检验结果之间的二元关联，并以行为改变指数为感兴趣的结果进行逻辑回归分析，将被认为具有显著性的预测因素纳入分析（p<0.1）。使用Atlas 3.0对定性数据进行主题内容分析。 结果：在1257名参与者中，1078人（85.8%）曾接受过艾滋病毒检测，其中74.2%在基贝拉HBTC项目中接受过检测。几乎所有人（97.4%）将HBTC体验评为优秀（62.4%）或良好（37%），并会向朋友推荐。与其他检测点的客户相比，HBTC客户中预防信息的提供率较高；减少性伴咨询（64%对52%）和忠诚（78.3%对67%）； p=0.001。HBTC后自我报告的行为改变普遍较低，使用避孕套的比例为10.7%，男性更有可能采取更安全的性行为（p = 0.002）。不使用避孕套的主要原因是信任性伴侣和担心被怀疑。之前检测结果为阴性后检测出艾滋病毒呈阳性的客户占3.4%。焦点小组讨论报告称，艾滋病毒阴性和阳性居民中都存在多个性伴侣关系。 结论：尽管在该社区中，HBTC期间提供的预防信息被接受和认可，但其在艾滋病毒阴性和阳性个体中的利用率都很低。迫切需要创新策略来改变关于性行为的规范性观念。
J Acquir Immune Defic Syndr. 2013-2-1
J Acquir Immune Defic Syndr. 2014-5-1
J Acquir Immune Defic Syndr. 2013-2-1
East Afr Med J. 2010-3
BMC Public Health. 2012-5-28
J Acquir Immune Defic Syndr. 2011-9-1
Zotero 插件