Gill Michelle M, Jahanpour Ola, van de Ven Roland, Barankena Asheri, Urasa Peris, Antelman Gretchen
Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.
Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.
PLoS One. 2021 Mar 25;16(3):e0248751. doi: 10.1371/journal.pone.0248751. eCollection 2021.
HIV risk screening tool validation studies have not typically included process evaluations to understand tool implementation. The study aim was to assess the fidelity to which an HIV risk screening tool was administered by lay workers and acceptability of delivering home-based screening coupled with HIV testing to beneficiaries in an orphans and vulnerable children (OVC) program.
This cross-sectional study was conducted March-April 2019 in two regions of Tanzania. Community case workers (CCW) were observed conducting screenings with OVC 2-19 years and participated in focus group discussions. Research staff used structured observation checklists to capture if screening questions were asked or reworded by CCW. In-depth interviews were conducted with older adolescents and caregivers in their homes following screening and testing. A composite score was developed for the checklist. Qualitative data were thematically analyzed to address screening and testing perceptions and experiences.
CCW (n = 32) participated in 166 observations. Commonly skipped items were malnutrition (34% of all observed screenings) and sexual activity and pregnancy (20% and 45% of screenings for adolescents only). Items frequently re-worded included child abuse (22%) and malnutrition (15%). CCW had an average composite observation score of 42/50. CCW in focus groups (n = 34) found the screening process acceptable. However, they described rewording some questions viewed as harsh or socially inappropriate to ask. Overall, adolescent beneficiaries (n = 17) and caregivers (n = 25) were satisfied with home-based screening and testing and reported no negative consequences. Learning one's HIV negative status was seen as an opportunity to discuss or recommit to healthy behaviors. While respondents identified multiple benefits of home testing, they noted the potential for privacy breaches in household settings.
We found sub-optimal fidelity to the administration of the screening tool by CCW in home environments to children and adolescents enrolled in an OVC program. Improvements to questions and their delivery and ongoing mentorship could strengthen tool performance and HIV case finding using a targeted testing approach. Overall, home-based HIV risk screening and testing were acceptable to beneficiaries and CCW, could improve testing uptake, and serve as a platform to promote healthy behaviors for those with limited health system interactions.
艾滋病毒风险筛查工具验证研究通常未纳入过程评估以了解工具的实施情况。本研究旨在评估外行人对艾滋病毒风险筛查工具的使用保真度，以及在孤儿和弱势儿童（OVC）项目中向受益人提供居家筛查及艾滋病毒检测的可接受性。
这项横断面研究于2019年3月至4月在坦桑尼亚的两个地区开展。观察社区个案工作者（CCW）对2至19岁的OVC进行筛查，并参与焦点小组讨论。研究人员使用结构化观察清单来记录CCW是否询问或重新表述了筛查问题。在筛查和检测后，对年龄较大的青少年及其家中的照顾者进行深入访谈。为清单制定了一个综合评分。对定性数据进行主题分析，以探讨筛查和检测的认知及经历。
32名CCW参与了166次观察。常见跳过的项目是营养不良（在所有观察到的筛查中占34%）以及性活动和怀孕（仅针对青少年的筛查中分别占20%和45%）。经常重新表述的项目包括虐待儿童（22%）和营养不良（15%）。CCW的平均综合观察评分为42/50。焦点小组中的34名CCW认为筛查过程是可接受的。然而，他们表示会重新表述一些被认为过于严厉或在社会上不合适询问的问题。总体而言，17名青少年受益人和25名照顾者对居家筛查和检测感到满意，并表示没有负面后果。得知自己艾滋病毒检测呈阴性被视为一个讨论或再次承诺采取健康行为的机会。虽然受访者指出了居家检测的多种好处，但他们也提到了家庭环境中存在隐私泄露的可能性。
我们发现，在居家环境中，CCW对参与OVC项目的儿童和青少年使用筛查工具的保真度未达最佳。对问题及其表述方式进行改进以及持续的指导可以加强工具的性能，并通过有针对性的检测方法提高艾滋病毒病例的发现率。总体而言，居家艾滋病毒风险筛查和检测为受益人和CCW所接受，可以提高检测率，并为那些与卫生系统互动有限的人提供一个促进健康行为的平台。
