Owuor Mercy, Wamuti Beatrice, Katz David A, Liu Wenjia, Lagat Harison, Kariithi Edward, Naughton Brienna, Kingston Hanley, Mugambi Mary, Bosire Rose, Masyuko Sarah, Farquhar Carey, Weiner Bryan J
CFK Africa, Nairobi, Kenya.
Department of Global Health, University of Washington, Seattle, Washington, USA.
BMJ Open. 2025 Mar 15;15(3):e088436. doi: 10.1136/bmjopen-2024-088436.
This study explores factors affecting community-level demand for assisted partner services (APS) and HIV testing services (HTS) in western Kenya.
This is a multilevel qualitative analysis conducted as part of the APS Scale-up Study, a hybrid type 2 implementation-effectiveness study of APS integrated within routine HTS. For this analysis, in-depth phone interviews assessed demand for APS and factors influencing decisions to participate in APS.
Participants were recruited from eight healthcare facilities and (for APS stakeholders) from affiliated healthcare institutions in western Kenya (Kisumu and Homabay). Interviews were conducted by phone in 2019 and 2020.
67 participants were interviewed: 14 APS providers, 16 female index clients, 17 male sexual partners and 20 community members. Participants were recruited using criteria-based purposive sampling to represent different types of facilities and to include indexes who named different numbers of partners and stakeholders representing all Kenyan healthcare system levels.
Collectively, participants perceived that demand and uptake of APS could be impacted by multiple stigmas related to HIV, sexual behaviours and identities; long clinical wait times; certain gender norms and expectations; and fear of relationship dissolution, loss of financial support and intimate partner violence. However, different stakeholder groups generally focused on different factors; women focused more on gender dynamics and family roles; male sexual partners on stigma and structural barriers; HTS providers focused on HIV testing accessibility; and community-level stakeholders focused on low community awareness of APS.
Stigma reduction, awareness about APS, creation of male entry points at the facility level and provision of social support mechanisms have the potential to increase demand for APS.
本研究探讨影响肯尼亚西部社区层面辅助伴侣服务（APS）和艾滋病毒检测服务（HTS）需求的因素。
这是一项多层次定性分析，作为APS扩大规模研究的一部分进行，APS扩大规模研究是一项将APS整合到常规HTS中的混合型2类实施效果研究。对于本分析，通过深入电话访谈评估了对APS的需求以及影响参与APS决策的因素。
参与者从肯尼亚西部（基苏木和霍马湾）的八家医疗机构以及（针对APS利益相关者）附属医疗机构招募。访谈于2019年和2020年通过电话进行。
共采访了67名参与者：14名APS提供者、16名女性指标客户、17名男性性伴侣和20名社区成员。参与者采用基于标准的目的抽样法招募，以代表不同类型的机构，并纳入提及不同数量伴侣的指标以及代表肯尼亚所有医疗系统层面的利益相关者。
总体而言，参与者认为，与艾滋病毒、性行为和身份相关的多种耻辱感、较长的临床等待时间、某些性别规范和期望，以及对关系破裂、失去经济支持和亲密伴侣暴力的恐惧，可能会影响APS的需求和接受度。然而，不同的利益相关者群体通常关注不同的因素；女性更多地关注性别动态和家庭角色；男性性伴侣关注耻辱感和结构障碍；HTS提供者关注艾滋病毒检测的可及性；社区层面的利益相关者关注社区对APS的低认知度。
减少耻辱感、提高对APS的认知、在机构层面设立男性参与点以及提供社会支持机制有可能增加对APS的需求。
