Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2023 Feb 14;18(2):e0279781. doi: 10.1371/journal.pone.0279781. eCollection 2023.
HIV self-testing (HIVST) is a promising strategy to increase awareness of HIV status among sub-Saharan African (SSA) men. Understanding user perspectives on HIVST secondary distribution from pregnant women attending antenatal care (ANC) to their male partners is crucial to optimizing delivery strategies.
We sampled pregnant women attending ANC without their partners and purposively oversampled pregnant women living with HIV (PWHIV) to understand their unique views. We recruited male partners after obtaining contact information from women. We conducted 14 focus group discussions and 10 in-depth interviews with men and pregnant women. We assessed acceptability of HIVST secondary distribution, barriers, facilitators, and interventions to increase HIVST uptake.
Participants felt that HIVST secondary distribution was acceptable, particularly for women in stable relationships. However, many expressed concerns about accusations of mistrust, relationship dissolution, fear of discovering serodifference, and lack of counseling associated with HIVST. PWHIV reported hesitation about secondary distribution, citing fears of unintended HIV status disclosure and abandonment resulting in financial hardship for themselves and their infant. Some participants preferred that providers contact men directly to offer HIVST kits instead of distribution via women. Participants reported that community sensitization, availability of phone-based counseling, male clinic staff, extended clinic hours, and financial incentives could increase men's HIVST use and linkage to care.
Participants expressed high interest in using HIVST, but secondary distribution was not universally preferred. We identified potential strategies to increase HIVST acceptability, particularly among PWHIV and those in unstable partnerships which can inform strategies to optimize HIVST distribution.
HIV 自我检测（HIVST）是提高撒哈拉以南非洲（SSA）男性对 HIV 状况认知的一项很有前景的策略。了解孕妇在接受产前保健（ANC）时将 HIVST 转递给其男性伴侣的意愿，对于优化传递策略至关重要。
我们从没有伴侣陪同的 ANC 孕妇中进行抽样，并有意对 HIV 阳性孕妇（PWHIV）进行抽样，以了解她们的独特观点。我们从女性那里获得联系方式后招募男性伴侣。我们对男性和孕妇进行了 14 次焦点小组讨论和 10 次深入访谈。我们评估了 HIVST 二级分发的可接受性、障碍、促进因素和干预措施，以增加 HIVST 的采用率。
参与者认为 HIVST 二级分发是可以接受的，特别是对于稳定关系中的女性。然而，许多人对不信任指控、关系破裂、害怕发现血清差异以及缺乏与 HIVST 相关的咨询表示担忧。PWHIV 对二级分发表示犹豫，他们担心无意中透露 HIV 状况会导致遗弃，从而给他们自己和他们的婴儿带来经济困难。一些参与者希望提供者直接联系男性提供 HIVST 试剂盒，而不是通过女性分发。参与者报告说，社区宣传、电话咨询的可用性、男性诊所工作人员、延长诊所工作时间和经济激励措施可以提高男性对 HIVST 的使用和与护理的联系。
参与者对使用 HIVST 表现出浓厚的兴趣，但二级分发并非普遍受到欢迎。我们确定了一些潜在的策略来提高 HIVST 的可接受性，特别是在 PWHIV 和那些不稳定关系中的人群中，这可以为优化 HIVST 分发策略提供信息。
