Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
BMC Infect Dis. 2022 Apr 21;22(Suppl 1):395. doi: 10.1186/s12879-022-07231-7.
Young people, aged 16-24, in southern Malawi have high uptake of HIV self-testing (HIVST) but low rates of linking to services following HIVST, especially in comparison, to older generations. The study aim is to explore the barriers and facilitators to linkage for HIV prevention and care following uptake of HIV self-testing among young Malawians.
We used qualitative methods. Young people aged 16-24 who had received HIVST; community-based distribution agents (CBDAs) and health care workers from the linked facilities were purposively sampled from two villages in rural southern Malawi.
We conducted in-depth interviews with thirteen young people (9 female) and held four focus groups with 28 healthcare workers and CBDAs. Young people strongly felt the social consequences associated with inadvertent disclosure of HIV sero-status were a significant deterrent to linkage at their stage in life. They also felt communication on testing benefits and the referral process after testing was poor. In contrast, they valued encouragement from those they trusted, other's positive treatment experiences and having a "strength of mind". CBDAs were important facilitators for young people as they are able to foster a trusting relationship and had more understanding of the factors which prevented young people from linking following HIVST than the healthcare workers. Young people noted contextual barriers to linkage, for example, being seen on the road to the healthcare centre, but also societal gendered barriers. For example, young females and younger adolescents were less likely to have the financial independence to link to services whilst young males (aged 19-24) had the finances but lacked a supportive network to encourage linkage following testing. Overall, it was felt that the primary "responsibility" for linking to formal healthcare following self-testing is shouldered by the young person and not the healthcare system.
Young people are happy to self-test for HIV but faced barriers to link to services following a self-test. Potential interventions for improving linkage suggested by this analysis include the establishment of youth-friendly linkage services, enhanced lines of communication between young people and healthcare providers and prioritising linkage for future interventions when targeting young people following HIVST.
在马拉维南部，16-24 岁的年轻人接受 HIV 自我检测（HIVST）的比例很高，但进行 HIVST 后与服务机构建立联系的比例却很低，与老一辈人相比尤其如此。本研究旨在探索在年轻的马拉维人中，接受 HIV 自我检测后，进行 HIV 预防和护理服务的联系的障碍和促进因素。
我们采用定性方法。从马拉维南部两个农村村庄中，选择了接受过 HIVST 的 16-24 岁年轻人、社区为基础的分发代理（CBDAs）和来自关联设施的卫生保健工作者，进行了深入访谈。
我们对 13 名年轻人（9 名女性）进行了深入访谈，并与 28 名卫生保健工作者和 CBDAs 进行了 4 次焦点小组讨论。年轻人强烈认为，无意间透露 HIV 血清状况相关的社会后果，是他们在这个人生阶段进行联系的一个重要障碍。他们还认为，检测收益的沟通和检测后的转介过程都很差。相比之下，他们更看重来自信任的人的鼓励、他人的积极治疗体验和“内心的力量”。CBDAs 是年轻人的重要促进因素，因为他们能够建立信任关系，并且比卫生保健工作者更了解阻止年轻人在 HIVST 后建立联系的因素。年轻人注意到联系的背景障碍，例如，在去医疗中心的路上被看到，但也注意到社会性别障碍。例如，年轻女性和年龄较小的青少年在经济上独立联系服务的可能性较小，而年轻男性（19-24 岁）有经济能力，但缺乏鼓励他们在检测后建立联系的支持网络。总的来说，人们认为，进行自我检测后，与正式医疗保健机构建立联系的主要“责任”应由年轻人承担，而不是医疗保健系统。
年轻人愿意进行 HIV 自我检测，但在进行自我检测后，与服务机构建立联系存在障碍。为了提高联系率，本分析提出了一些潜在的干预措施，包括建立适合年轻人的联系服务、加强年轻人和医疗保健提供者之间的沟通，并在针对接受 HIVST 后的年轻人进行未来干预时，将联系作为优先事项。
