A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa

Abstract

BackgroundDespite Sub-Saharan Africa (SSA) being the epicenter of the HIV epidemic, uptake of HIV testing is not optimal. While qualitative studies have been undertaken to investigate factors influencing uptake of HIV testing, systematic reviews to provide a more comprehensive understanding are lacking.MethodsUsing Noblit and Hare’s meta-ethnography method, we synthesised published qualitative research to understand factors enabling and deterring uptake of HIV testing in SSA. We identified 5,686 citations out of which 56 were selected for full text review and synthesised 42 papers from 13 countries using Malpass’ notion of first-, second-, and third-order constructs.ResultsThe predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. Other enabling factors are availability of treatment and social network influence and support. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality which undermines women’s decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing.ConclusionsImproving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs of seeking HIV testing could also contribute towards increasing uptake of HIV testing in SSA.

Factor Influencing HIV Care Continuum among People Living with HIV in Western Kenya

“…This study found that ART uptake stood at 53.72% which is similar to ART uptake reported in western Kenya [20], which is below the national ART coverage that stand at 78.5% [12]. This may be due to poor linkage on HIV care and management in this region which stands at 29.1% except for those tested at VCTs where the linkage is at 99.6% [22].…”

“…The other hindrance to ART uptake is HIV related stigma. Indeed, HIV related stigma and discrimination have been identified as major barriers to uptake HIV related prevention services [12]. It adversely influences decisions to seek HIV testing In South Africa and Nigeria studies have shown that stigma is an important barrier to uptake of HIV testing and ART services.…”

“…counseling and testing among pregnant women is at 92.20%, coverage of PMTCT ARV at 70.60%, number of infants born to HIV positive mother receiving a virological test for HIV within 2 months of birth at 45%, the eligible PLHIV on ART at 80% and a retention rate about 92% within the first month [12,20]. Despite this achievement at national level there is a paucity of data on the factors that may be leading to poor linkage to HIV care especially at county level although there is geographical variation in HIV prevalence [11].…”

“…For example, HIV testing coverage in Kenya in men is around 36% while for women it is around 47% and there has been a steady increase for adults tested for HIV from 860,000 in 2008 to 6.4 million in 2013 [12]. However, national coverage may mask intra-county variation in uptake of HTC [4].…”

A Multilevel Analysis of the Determinants of HIV Testing in Zimbabwe: Evidence from the Demographic and Health Surveys

“…The highest proportion (58%) was observed among females in the age group (25)(26)(27)(28)(29); compared to males (38%) in same age group. For both males and females, HIV testing coverage was lowest among individuals below the age of 20 years, followed by those aged 40 years and above.…”