School of Nursing, University of Washington, Seattle, USA.
Department of Global Health, University of Washington, Seattle, USA.
BMC Health Serv Res. 2022 May 7;22(1):616. doi: 10.1186/s12913-022-08024-z.
Assisted partner service (APS) is effective for increasing HIV testing services (HTS) uptake among sexual partners of people diagnosed with HIV with rare social harm. The acceptability of APS to HTS providers is important for the quality and effectiveness of APS delivery. Within a larger ongoing implementation science study of APS in western Kenya, we qualitatively evaluated the provider acceptability of APS.
From May-June 2020, we conducted virtual, semi-structured in-depth interviews with 14 HTS providers recruited from 8 of 31 study health facilities in Homa Bay and Kisumu counties. Participants were selected using criteria-based purposive sampling to maximize variation on patient volume (assessed by the number of index clients tested for HIV) and APS performance (assessed by sexual partners elicitation and enrollment). Interviews inquired providers' experiences providing APS including challenges and facilitators and the impact of contextual factors. Data were analyzed using an inductive approach.
Overall, HTS providers found APS acceptable. It was consistently reported that doing APS was a continuous process rather than a one-day job, which required building rapport and persistent efforts. Benefits of APS including efficiency in HIV case finding, expanded testing coverage in men, and increased HIV status awareness and linkage to care motivated the providers. Provider referral was perceived advantageous in terms of independent contact with partners on behalf of index clients and efficiency in partner tracing. Challenges of providing APS included protecting clients' confidentiality, difficulty obtaining partners' accurate contact information, logistic barriers of tracing, and clients' refusal due to fear of being judged for multiple sexual partners, fear of breach of confidentiality, and HIV stigma. Building rapport with clients, communicating with patience and nonjudgmental attitude and assuring confidentiality were examples of facilitators. Working in rural areas and bigger facilities, training, supportive supervision, and community awareness of APS promoted APS delivery while low salaries, lack of equipment, and high workload undermined it.
HTS providers found APS acceptable. Delivering APS as a process was the key to success. Future scale-up of APS could consider encouraging provider referral instead of the other APS methods to improve efficiency and reduce potential harm to clients.
辅助伴侣服务（APS）对于提高艾滋病毒感染者性伴侣的艾滋病毒检测服务（HTS）接受率非常有效，且对社会造成的危害极小。辅助伴侣服务对 HTS 提供者的可接受性对于辅助伴侣服务的提供质量和效果非常重要。在肯尼亚西部一项正在进行的关于辅助伴侣服务的实施科学研究中，我们从定性的角度评估了提供者对辅助伴侣服务的可接受性。
2020 年 5 月至 6 月，我们对来自霍马贝和基苏木县 31 个研究保健设施中的 8 个的 14 名 HTS 提供者进行了虚拟、半结构化的深入访谈。参与者是根据基于标准的目的抽样选择的，以最大限度地扩大患者数量（通过检测艾滋病毒的索引客户数量来评估）和辅助伴侣服务表现（通过性伴侣的招募和入组来评估）的变化。访谈询问了提供者提供辅助伴侣服务的经验，包括挑战和促进因素以及背景因素的影响。数据采用归纳法进行分析。
总体而言，HTS 提供者认为辅助伴侣服务是可以接受的。他们一致认为，提供辅助伴侣服务是一个持续的过程，而不是一天的工作，需要建立融洽关系和持续的努力。辅助伴侣服务的好处包括提高 HIV 病例发现效率、扩大男性检测覆盖面以及提高 HIV 知晓率和促进艾滋病毒感染者获得护理，这激发了提供者的积极性。提供者认为转诊具有优势，因为可以代表索引客户与伴侣进行独立接触，并且可以提高伴侣追踪的效率。提供辅助伴侣服务的挑战包括保护客户的机密性、难以获得伴侣准确的联系方式、追踪方面的后勤障碍以及客户因害怕被评判有多个性伴侣、担心机密信息泄露和 HIV 污名化而拒绝接受检测。与客户建立融洽关系、耐心和非评判性地沟通以及保证保密性是促进因素的例子。在农村地区和较大的设施中工作、培训、支持性监督以及社区对辅助伴侣服务的认识有助于辅助伴侣服务的提供，而低工资、缺乏设备和高工作量则会破坏辅助伴侣服务的提供。
HTS 提供者认为辅助伴侣服务是可以接受的。将提供辅助伴侣服务作为一个过程是成功的关键。未来扩大辅助伴侣服务的规模可以考虑鼓励提供者转诊，而不是其他辅助伴侣服务方法，以提高效率并减少对客户造成的潜在伤害。
