Nangendo Joanita, Wanyenze Rhoda K, Obeng-Amoako Gloria O, Muwema Mercy, Mukisa John, Okiring Jaffer, Kabami Jane, Karamagi Charles A, Semitala Fred C, Kalyango Joan N, Kamya Moses R, Katahoire Anne R
Makerere University School of Medicine.
Makerere University College of Health Sciences.
Res Sq. 2024 Jan 26:rs.3.rs-3816613. doi: 10.21203/rs.3.rs-3816613/v1.
BACKGROUND: HIV self-testing (HIVST) is a practical and effective way to provide HIV testing services to at-risk and underserved populations, particularly men. Utilizing Village Health Teams (VHTs) could enhance community-based delivery of oral HIVST to reach the last un-tested individuals who may be at-risk of infection. However, little is known about what VHTs and facility-based healthcare workers think about facilitating oral HIVST and delivery of subsequent HIV services. We investigated the views of health providers on oral HIVST delivered by VHTs among men in rural communities in Central Uganda. METHODS: We conducted a qualitative study in Mpigi district, interviewing 27 health providers who facilitated oral HIV self-testing among men. The providers consisting of 15 VHTs and 12 facility-based health workers were purposively selected. All interviews were audio-recorded, transcribed verbatim, and translated to English for a hybrid inductive-deductive thematic analysis. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Implementation Science framework to generate and categorize open codes. RESULTS: In terms of reaching men with HIV testing services, the providers considered HIVST to be a fast and convenient method, which could boost HIV testing. However, they also had concerns about its accuracy. In terms of effectiveness, HIVST was perceived as a reliable, user-friendly, and efficient approach to HIV testing. However, it depended on the user's preference for testing algorithms. Regarding adoption, HIVST was considered to enhance autonomy, well-suited for use in the community, and offered opportunities for linkage and re-linkage into care. However, at times HIVST faced hesitance. As for Implementation, VHTs had various support roles in HIVST but had concerns about social insecurities and delays in seeking subsequent facility-based services after HIVST. Regarding Maintenance, providers recommended several ways to improve oral HIVST including; optimizing tracking of HIVST distribution and use, improving linkage and retention in care after HIVST, diversifying HIVST for combined HIV prevention packages and including more languages, broadening sensitization among potential HIVST users and health providers, differentiating distribution models, and prioritizing targeted HIVST efforts. CONCLUSION: HIVST has the potential to increase testing rates and engagement of men in HIV services. However, for it to be implemented on a population-wide scale, continuous sensitization of potential users and health providers is necessary, along with streamlined structures for tracking kit distribution, use, and reporting of results. Further implementation research may be necessary to optimize the role of health providers in facilitating HIVST.
背景:艾滋病毒自我检测(HIVST)是一种为高危人群和服务不足人群,尤其是男性,提供艾滋病毒检测服务的切实有效的方法。利用乡村卫生团队(VHTs)可以加强基于社区的口服HIVST服务,以覆盖可能有感染风险的最后一批未检测个体。然而,对于VHTs和医疗机构的医护人员对促进口服HIVST及后续艾滋病毒服务的看法知之甚少。我们调查了乌干达中部农村社区男性中卫生服务提供者对VHTs提供的口服HIVST的看法。 方法:我们在姆皮吉区进行了一项定性研究,采访了27名促进男性口服艾滋病毒自我检测的卫生服务提供者。这些提供者包括15名VHTs成员和12名医疗机构的医护人员,是经过有目的选择的。所有访谈都进行了录音,逐字转录,并翻译成英文进行混合归纳-演绎主题分析。我们使用“覆盖、效果、采用、实施和维持”(RE-AIM)实施科学框架来生成和分类开放编码。 结果:在为男性提供艾滋病毒检测服务方面,提供者认为HIVST是一种快速便捷的方法,可以提高艾滋病毒检测率。然而,他们也担心其准确性。在效果方面,HIVST被认为是一种可靠、用户友好且高效的艾滋病毒检测方法。然而,这取决于用户对检测算法的偏好。关于采用情况,HIVST被认为可以增强自主性,非常适合在社区使用,并为联系和重新联系到护理提供了机会。然而,HIVST有时会面临犹豫。至于实施方面,VHTs在HIVST中发挥了各种支持作用,但对社会不安全因素以及HIVST后寻求后续医疗机构服务的延迟表示担忧。关于维持方面,提供者建议了几种改进口服HIVST的方法,包括:优化HIVST分发和使用的跟踪,改善HIVST后护理的联系和留存,使HIVST多样化以纳入综合艾滋病毒预防套餐并增加语言种类,扩大对潜在HIVST使用者和卫生服务提供者的宣传,区分分发模式,并优先开展有针对性的HIVST工作。 结论:HIVST有潜力提高检测率并增加男性参与艾滋病毒服务的程度。然而,要在全人群范围内实施,有必要持续提高潜在使用者和卫生服务提供者的认识,同时简化试剂盒分发、使用和结果报告的跟踪结构。可能需要进一步的实施研究来优化卫生服务提供者在促进HIVST方面的作用。
BMC Health Serv Res. 2017-11-28