Dzinamarira Tafadzwa, Kamanzi Collins, Mashamba-Thompson Tivani Phosa
Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa.
College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 3286, Rwanda.
Diagnostics (Basel). 2020 Apr 1;10(4):194. doi: 10.3390/diagnostics10040194.
The World Health Organisation recommends HIV self-testing as an alternative testing method to help reach underserved populations, such as men in sub-Saharan Africa. Successful implementation and scale-up of HIV self-testing (HIVST) in Rwanda relies heavily on relevant stakeholders' involvement. We sought to explore HIVST key stakeholders' perceptions of the implementation and scale-up of HIVST in Rwanda.
We conducted in-depth interviews with personnel involved in HIV response projects in Rwanda between September and November 2019. We purposively sampled and interviewed 13 national-level key stakeholders from the Ministry of Health, Rwanda Biomedical Center, non-governmental organizations and HIV clinics at tertiary health facilities in Kigali. We used a thematic approach to analysis with a coding framework guided by Consolidated Framework for Implementation Research (intervention characteristics, inner setting, outer setting, characteristics of individuals involved in the implementation and the implementation process).
Key stakeholders perceived HIVST as a potentially effective initiative, which can be used in order to ensure that there is an improvement in uptake of testing services, especially for underserved populations in Rwanda. The following challenges for implementation and scale-up of HIVST were revealed: lack of awareness of the kits, high cost of the self-test kits, and concerns on results interpretation. Key stakeholders identified the following as prerequisites to the successful implementation and scale-up of HIVST in Rwanda; creation of awareness, training those involved in the implementation process, regulation of the selling of the self-test kits, reduction of the costs of acquiring the self-test kits through the provision of subsidies, and ensuring consistent availability of the self-test kits.
Key stakeholders expressed confidence in HIVST's ability to improve the uptake of HIV testing services. However, they reported challenges, which need to be addressed to ensure successful implementation and scale-up of the HIVST. There is a need for further research incorporating lower level stakeholders to fully understand HIVST implementation and scale-up challenges and strategies to inform policy.
世界卫生组织建议将艾滋病毒自我检测作为一种替代检测方法，以帮助覆盖服务不足的人群，例如撒哈拉以南非洲的男性。在卢旺达成功实施和扩大艾滋病毒自我检测（HIVST）严重依赖相关利益攸关方的参与。我们试图探讨卢旺达艾滋病毒自我检测关键利益攸关方对实施和扩大艾滋病毒自我检测的看法。
2019年9月至11月期间，我们对卢旺达参与艾滋病毒应对项目的人员进行了深入访谈。我们有目的地抽样并采访了来自卫生部、卢旺达生物医学中心、非政府组织以及基加利三级卫生设施的艾滋病毒诊所的13名国家级关键利益攸关方。我们采用主题分析法进行分析，使用由实施研究综合框架（干预特征、内部环境、外部环境、参与实施的个人特征和实施过程）指导的编码框架。
关键利益攸关方认为艾滋病毒自我检测是一项潜在有效的举措，可用于确保检测服务的接受度有所提高，特别是对卢旺达服务不足的人群。揭示了艾滋病毒自我检测实施和扩大面临的以下挑战：对检测试剂盒缺乏认识、自我检测试剂盒成本高以及对结果解读的担忧。关键利益攸关方确定了以下是卢旺达成功实施和扩大艾滋病毒自我检测的先决条件；提高认识、培训参与实施过程的人员、规范自我检测试剂盒的销售、通过提供补贴降低获取自我检测试剂盒的成本以及确保自我检测试剂盒的持续供应。
关键利益攸关方对艾滋病毒自我检测改善艾滋病毒检测服务接受度的能力表示有信心。然而，他们报告了一些挑战，需要加以解决以确保艾滋病毒自我检测的成功实施和扩大。有必要进行进一步研究，纳入较低层级的利益攸关方，以充分了解艾滋病毒自我检测实施和扩大的挑战及策略，为政策提供信息。
