Wirawan Gede Benny Setia, Januraga Pande Putu, Mahendra I Gusti Agung Agus, Harjana Ngakan Putu Anom, Mahatmi Tiara, Luhukay Lanny, Rewari Bharat Bhushan, Johnson Cheryl, Katz David A
Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia.
World Health Organization Indonesia, Jakarta, Indonesia.
BMC Public Health. 2021 Jan 30;21(1):254. doi: 10.1186/s12889-021-10332-8.
Voluntary assisted partner notification (aPN) services are effective in increasing access to and uptake of HIV testing among partners of people with HIV. Following recommendations by the World Health Organization in 2016, Indonesia evaluated various approaches to aPN. We present the lessons learned from formative operational research undertaken to understand provider and patient perspectives on aPN from three demonstration sites in cities with a high HIV burden.
We conducted a formative qualitative study in three cities: Jakarta, Semarang, and Denpasar between September and October 2019. We conducted six focus group discussions (FGDs) (n = 44 participants) among health-care providers, people living with HIV and the general population. We explored participant preferences and concerns about how aPN should be delivered, including the methods of and messaging for contacting partners. All FGDs were conducted in the Indonesian language. Qualitative data were analysed using thematic analysis.
aPN was acceptable across different participant populations, although with caveats. Some differences were observed between the general population, providers and people living with HIV. People living with HIV were mainly concerned with confidentiality of the procedure and preferred the use of telecommunication and messages that avoid explicit mention of HIV exposure. Providers preferred similar approaches but for different reasons, being concerned mainly with self-efficacy and security. There was consensus regarding dual referral models. The use of phone calls and short messages were preferred as these are perceived to minimize negative reactions and stigma, protect client confidentiality and are suitable in the current legal situation. The general population was mainly concerned with effectiveness and prefer direct provider-led approaches, such as preferring in-person meeting with explicit notification of potential HIV exposure.
We found consensus among stakeholders on acceptance of aPN, especially dual referral methods. Development and implementation of aPN protocols should also consider clients' individual situations and concerns regarding safeguarding of confidentiality, and offer a range of options to accommodate all stakeholders involved.
自愿辅助性伴侣通知（aPN）服务在增加艾滋病毒感染者的伴侣获得艾滋病毒检测并接受检测方面是有效的。根据世界卫生组织2016年的建议，印度尼西亚评估了aPN的各种方法。我们介绍了从形成性行动研究中吸取的经验教训，该研究旨在了解艾滋病毒负担高的城市的三个示范点的提供者和患者对aPN的看法。
2019年9月至10月期间，我们在雅加达、三宝垄和登巴萨三个城市进行了一项形成性定性研究。我们在医疗保健提供者、艾滋病毒感染者和普通人群中进行了六次焦点小组讨论（FGD）（n = 44名参与者）。我们探讨了参与者对aPN应如何提供的偏好和担忧，包括联系伴侣的方法和信息传递方式。所有FGD均使用印尼语进行。定性数据采用主题分析进行分析。
aPN在不同的参与者群体中是可以接受的，尽管有一些注意事项。在普通人群、提供者和艾滋病毒感染者之间观察到了一些差异。艾滋病毒感染者主要关注该程序的保密性，更喜欢使用避免明确提及艾滋病毒暴露的电信和信息。提供者出于不同原因更喜欢类似的方法，主要关注自我效能感和安全性。对于双重转诊模式存在共识。人们更喜欢使用电话和短信，因为这些被认为可以将负面反应和耻辱感降至最低，保护客户的保密性，并且适合当前的法律情况。普通人群主要关注有效性，更喜欢由提供者直接主导的方法，例如更喜欢亲自会面并明确告知潜在的艾滋病毒暴露情况。
我们发现利益相关者在接受aPN方面达成了共识，特别是双重转诊方法。aPN协议的制定和实施还应考虑客户的个人情况以及对保密保护的担忧，并提供一系列选择以适应所有相关利益者。
