Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
Busitema University Faculty of Health Sciences, Mbale, Uganda.
BMC Public Health. 2020 Oct 20;20(1):1582. doi: 10.1186/s12889-020-09714-1.
BACKGROUND: Despite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care in Kasensero fishing community in rural Uganda. METHODS: This qualitative study was conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, in May 2019. Six single-sex focus group discussions (FGDs) comprising 7-8 participants were conducted with adolescents and young people (15-24 years) and adult men (25+ years). We collected data on people's perceptions about peer-led HIVST; potential acceptability of a peer-led HIVST intervention and suggestions on how to improve linkage to HIV care after a positive HIVST result. Peer-led HIVST was defined as an approach where trained lay people distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. RESULTS: Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the fishing community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community "because [the peer-leader] could be my immediate neighbour", making it easier for people to obtain the kits at any time of their convenience. To improve linkage to HIV care, participants felt that the use of peer-leaders to deliver the initial ART dose to self-tested HIV-positive individuals would be more preferable to the use of community-based ART groups or home-based ART initiation. CONCLUSION: Our study shows that peer-led HIVST is potentially acceptable in the fishing community. These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services.
背景：尽管努力提高青少年、年轻人和成年男性的 HIV 检测和与 HIV 护理的衔接率，但这些比率仍低于全球目标。我们进行了形成性研究，以获取必要的数据，为在乌干达农村卡森塞罗渔业社区开展以同伴为主导的 HIV 自我检测（HIVST）干预提供信息，以提高 HIV 检测率和与 HIV 护理的衔接率。
方法：本定性研究于 2019 年 5 月在乌干达拉凯区卡森塞罗渔业社区的三个研究社区进行。我们对青少年和年轻人（15-24 岁）和成年男性（25 岁以上）进行了六组男女分开的焦点小组讨论（FGD），每组由 7-8 名参与者组成。我们收集了有关人们对同伴主导的 HIVST 的看法；对同伴主导的 HIVST 干预措施的潜在接受程度；以及对如何改善 HIV 阳性检测结果后的 HIV 护理衔接的建议。同伴主导的 HIVST 是指经过培训的非专业人员向社区中的其他人分发 HIVST 工具包的方法。在参与者的允许下，FGD 被录音，逐字转录，并按照主题框架方法进行手动分析。
结果：47 名参与者（31 名男性和 16 名女性）参加了 FGD。在各个社区和年龄组中，大多数参与者表示，同伴主导的 HIVST 在渔业社区中通常会被人们接受，但人们需要支持来进行检测，因为他们担心检测错误或无法应对 HIV 阳性结果。大多数参与者认为，同伴主导的 HIVST 将使 HIV 检测服务更接近社区，“因为[同伴领袖]可能是我隔壁的邻居”，使人们更容易在方便的时候获得工具包。为了改善与 HIV 护理的衔接，参与者认为，使用同伴领导者向自我检测 HIV 阳性的人提供初始 ART 剂量，比使用社区为基础的 ART 小组或家庭为基础的 ART 起始更可取。
结论：我们的研究表明，同伴主导的 HIVST 在渔业社区中具有潜在的可接受性。这些发现表明，这种方法可以提高通常通过常规 HIV 检测服务错过的人群的 HIV 检测率和与 HIV 护理服务的衔接率。
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