Population Council, Nairobi, Kenya.
Nairobi City County, County Health Services, Nairobi, Kenya.
PLoS One. 2020 Apr 15;15(4):e0231645. doi: 10.1371/journal.pone.0231645. eCollection 2020.
HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of ≥500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, health-care system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.
HIV 检测服务是 HIV 项目的重要组成部分，为新诊断出 HIV 的人提供了临床护理的切入点。尽管肯尼亚的 HIV 检测率有所提高，但男性接受检测和获得服务的可能性仍然低于女性。然而，人们对该国男性进行 HIV 检测的背景、障碍和促进因素的了解有限。本研究的数据来自对 30 名感染 HIV 的男性和 8 名 HIV 检测咨询师的深入访谈，旨在深入了解内罗毕市男性进行 HIV 检测的动机和驱动因素。通过检查早期和晚期诊断（例如 CD4≥500 个细胞/mm³，早期诊断和<500 个细胞/mm³，晚期诊断）的临床 CD4 登记册，追溯性地确定了男性。分析涉及确定广泛的主题，并生成描述性代码和类别。早期检测的时间与强大的社会支持系统和检测机构有关，而检测成本、检测机构的选择以及薄弱的社会支持系统（尤其是糟糕的伴侣关系）导致了晚期检测。在检测前很少进行讨论，只有在与伴侣或其他近亲进行对话时才会进行讨论。个人、医疗保健系统和人际层面的相互关联的障碍阻碍了对检测服务的获取。具体而言，检测障碍包括感知到提供者的态度、机构位置和设置、等待时间/不方便的就诊时间、低风险感知、有限的 HIV 知识、耻辱感、歧视和对检测的恐惧。高风险感知、重病、知晓伴侣的状况、保密性、服务和用品的质量、灵活/延长的开放时间以及检测前后的咨询是促进因素。早期和晚期检测者的经验有重叠之处，尽管存在一些细微的差异。为了在全国范围内实现预期的影响，并实现 90-90-90 目标，需要采取多种干预措施，既解决检测的障碍，也解决检测的促进因素，以提高检测的参与度，并将阳性结果与护理联系起来。
