Naughton Brienna, Owuor Mercy, Wamuti Beatrice, Katz David A, Sharma Monisha, Liu Wenjia, Lagat Harison, Kariithi Edward, Mugambi Mary, Bosire Rose, Masyuko Sarah, Farquhar Carey, Weiner Bryan J
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PATH-Kenya, Kisumu, Kenya.
PLOS Glob Public Health. 2023 May 24;3(5):e0001842. doi: 10.1371/journal.pgph.0001842. eCollection 2023.
INTRODUCTION: Assisted partner services (APS), or notification for sexual partners of people diagnosed with HIV, is an efficient, effective, and high yield strategy to identify people living with HIV and is recommended by the World Health Organization (WHO). However, there remains a need to further understand the acceptability of APS qualitatively from a client lens, particularly when APS is integrated into the national health system. We investigated acceptability of APS when integrated into HIV services in Kenya. METHODS: Starting in May 2018, APS was implemented in 31 health facilities in Kisumu and Homa Bay counties in western Kenya. From January to December 2019, we conducted in-depth interviews (IDIs) with female index clients (n = 16) and male sexual partners (n = 17) in 10 facilities participating in an APS scale up study. Interviews assessed APS satisfaction, perceived benefits of the intervention, and challenges that may affect delivery or uptake. We applied the Theoretical Framework of Acceptability by Sekhon et al. (2017) as a guide to organize our findings. RESULTS: We find that views of APS are often guided by an individual's trust in the intervention's design and implementation, and an interest to preserve one's health and that of one's family and children. There were strong and consistent acceptable views of APS as "doing good" and "saving a life" and as a means of showing love towards one's partner(s). The initial acceptability framing of individuals engaging with APS was predicated either on a feeling of comfort with the intervention, or a wariness of divulging sex partner personal information. Health care workers (HCWs) were seen to play an important role in mitigating participant fears linked with the intervention, particularly around the sensitive nature of HIV disclosure and sexual partners. Clients noted considerable challenges that affected acceptability, including the risk to the relationship of disclosing one's HIV status, and the risk of intimate partner violence. DISCUSSION: We found that APS is acceptable as a strategy to reach male sexual partners of females diagnosed with HIV, and these findings provide opportunities to inform recommendations for further scale-up. Opportunities such as focusing on intervention confidentiality and appropriate counseling, excluding female clients at risk of IPV from this intervention, and highlighting the altruistic benefits of APS to potential clients. Understanding the perspectives of clients receiving APS in a real-world setting may be valuable to policy-makers and stakeholders interested in scaling up or enhancing APS within health systems.
引言:性伴协助服务(APS),即对被诊断感染艾滋病毒者的性伴进行通知,是一种识别艾滋病毒感染者的高效、有效且成功率高的策略,世界卫生组织(WHO)对此予以推荐。然而,仍有必要从服务对象的角度进一步定性了解APS的可接受性,尤其是当APS被纳入国家卫生系统时。我们调查了APS在肯尼亚纳入艾滋病毒服务时的可接受性。 方法:从2018年5月开始,在肯尼亚西部的基苏木县和霍马湾县的31个医疗机构实施了APS。2019年1月至12月,我们对参与APS扩大规模研究的10个机构中的女性索引服务对象(n = 16)和男性性伴(n = 17)进行了深入访谈(IDI)。访谈评估了对APS的满意度、该干预措施的感知益处以及可能影响服务提供或接受的挑战。我们以塞洪等人(2017年)的可接受性理论框架为指导来组织我们的研究结果。 结果:我们发现,对APS的看法通常受个人对干预措施设计和实施的信任以及保护自身、家人和孩子健康的意愿所引导。对于APS,存在强烈且一致的可接受观点,即认为它“有益”“拯救生命”,是向性伴表达爱意的一种方式。参与APS的个人最初的可接受性框架要么基于对干预措施的舒适感,要么基于对泄露性伴个人信息的警惕。医护人员在减轻参与者与干预措施相关的恐惧方面发挥着重要作用,尤其是围绕艾滋病毒披露和性伴的敏感性。服务对象指出了影响可接受性的诸多挑战,包括披露自身艾滋病毒感染状况对关系的风险以及亲密伴侣暴力的风险。 讨论:我们发现,APS作为一种接触被诊断感染艾滋病毒女性的男性性伴的策略是可接受的,这些研究结果为为进一步扩大规模提供建议提供了机会。诸如关注干预措施的保密性和适当咨询、将有亲密伴侣暴力风险的女性服务对象排除在该干预措施之外以及向潜在服务对象强调APS的利他益处等机会。了解在现实环境中接受APS的服务对象的观点,对于有兴趣在卫生系统内扩大或加强APS的政策制定者和利益相关者可能是有价值的。
J Acquir Immune Defic Syndr. 2021-1-1
AIDS Patient Care STDS. 2016-11
PLOS Glob Public Health. 2024-11-15
Int J Integr Care. 2024-11-8
J Acquir Immune Defic Syndr. 2021-1-1
Int J Health Policy Manag. 2021-10-1