How pregnant women living with HIV and their male partners manage men's HIV self‐testing: qualitative analysis of an HIVST secondary distribution process in Kampala, Uganda

Ware, Norma C.; Wyatt, Monique A.; Pisarski, Emily E; Kamusiime, Brenda; Kasiita, Vicent; Nalukwago, Grace Kakoola; Nalumansi, Alisaati; Twesigye, Collins; Boyer, Jade; Nakyanzi, Agnes; Naddunga, Faith; Mujugira, Andrew; Celum, Connie

doi:10.1002/jia2.26050

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Most relationships were highly stable-the majority were married, had children together, and were in a relationship for a mean of 9 years-which may result in greater trust and confidence in their relationship, facilitating safe HIVST distribution. Other studies in Uganda and South Africa show that women who have not yet disclosed their HIV-positive status may be apprehensive about HIVST distribution and fear negative repercussions from male partners [26,40]. Additional research is needed to assess how index HIVST performs among individuals in non-married and/or unstable relationships, particularly when the ART client has not yet disclosed their status.…”

Section: Plos Medicinementioning

confidence: 99%

Effect of index HIV self-testing for sexual partners of clients enrolled in antiretroviral therapy (ART) programs in Malawi: A randomized controlled trial

Dovel

Balakasi²,

Phiri³

et al. 2023

PLoS Med

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Background HIV testing among the sexual partners of HIV–positive clients is critical for case identification and reduced transmission in southern and eastern Africa. HIV self-testing (HIVST) may improve uptake of HIV services among sexual partners of antiretroviral therapy (ART) clients, but the impact of HIVST on partner testing and subsequent ART initiation remains unclear. Methods and findings We conducted an individually randomized, unblinded trial to assess if an index HIVST intervention targeting the partners of ART clients improves uptake of testing and treatment services in Malawi. The trial was conducted at 3 high-burden facilities in central and southern Malawi. ART clients attending HIV treatment clinics were randomized using simple randomization 1:2·5 to: (1) standard partner referral slip (PRS) whereby ART clients were given facility referral slips to distribute to their primary sexual partners; or (2) index HIVST whereby ART clients were given HIVST kits + HIVST instructions and facility referral slips to distribute to their primary sexual partners. Inclusion criteria for ART clients were: ≥15 years of age, primary partner with unknown HIV status, no history of interpersonal violence (IPV) with partner, and partner lives in facility catchment area. The primary outcome was partner testing 4-weeks after enrollment, reported by ART clients using endline surveys. Medical chart reviews and tracing activities with partners with a reactive HIV test measured ART initiation at 12 months. Analyses were conducted based on modified intention-to-treat principles, whereby we excluded individuals who did not have complete endline data (i.e., were loss to follow up from the study). Adjusted models controlled for the effects of age and marital status. A total of 4,237 ART clients were screened and 484 were eligible and enrolled (77% female) between March 28, 2018 and January 5, 2020. A total of 365 participants completed an endline survey (257/34 index HIVST arm; 107/13 PRS arm) and were included in the final analysis (78% female). Testing coverage among sexual partners was 71% (183/257) in the index HIVST arm and 25% (27/107) in the PRS arm (aRR: 2·77, 95% CI [2·56 to 3·00], p ≤ 0.001). Reported HIV positivity rates did not significantly differ by arm (16% (30/183) in HIVST versus 15% (4/27) in PRS; p = 0.99). ART initiation at 12 months was 47% (14/30) in HIVST versus 75% (3/4) in PRS arms; however, index HIVST still resulted in a 94% increase in the proportion of all partners initiating ART due to higher HIV testing rates in the HIVST arm (5% partners initiated ART in HVIST versus 3% in PRS). Adverse events including IPV and termination of the relationship did not vary by arm (IPV: 3/257 index HIVST versus 4/10 PRS; p = 0.57). Limitations include reliance on secondary report by ART clients, potential social desirability bias, and not powered for sex disaggregated analyses. Conclusions Index HIVST significantly increased HIV testing and the absolute number of partners initiating ART in Malawi, without increased risk of adverse events. Additional research is needed to improve linkage to HIV treatment services after HIVST use. Trial registration ClinicalTrials.gov, NCT03271307, and Pan African Clinical Trials, PACTR201711002697316.

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Section: Plos Medicinementioning

confidence: 99%

Effect of index HIV self-testing for sexual partners of clients enrolled in antiretroviral therapy (ART) programs in Malawi: A randomized controlled trial

Dovel

Balakasi²,

Phiri³

et al. 2023

PLoS Med

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“…Each participant took part in a single in-person qualitative interview guided by a semi-structured discussion guide (Additional file 1). The guide was developed collaboratively by the research team based on literature reviews, previous experiences working with PWUD and PWID populations in other settings, and knowledge of existing PrEP and harm reduction service delivery models and programs [19][20][21][22][23][24]. Participant interviews covered: (1) drug use experiences, (2) harm reduction knowledge and experiences, (3) HIV risk and risk perception, (4) knowledge and use of oral PrEP, and (5) perspectives of COVID-19 mitigation measures.…”

Section: Data Collectionmentioning

confidence: 99%

“Take services to the people”: strategies to optimize uptake of PrEP and harm reduction services among people who inject drugs in Uganda

Kamusiime,

Beima-Sofie,

Chhun

et al. 2024

Addict Sci Clin Pract

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Background People who inject drugs (PWID) are at increased risk of HIV acquisition and often encounter barriers to accessing healthcare services. Uganda has high HIV prevalence among PWID and lacks integrated pre-exposure prophylaxis (PrEP) and harm reduction services. Understanding PWID experiences accessing and using harm reduction services and PrEP will inform strategies to optimize integration that align with PWID needs and priorities. Methods Between May 2021 and March 2023, we conducted semi-structured interviews with PWID in Kampala, Uganda. We recruited participants with and without previous experience accessing harm reduction services and/or PrEP using purposive and snowball sampling. Interviews were audio recorded, translated, and transcribed. We used thematic analysis to characterize motivations for uptake of harm reduction and HIV prevention services, and strategies to optimize delivery of needle and syringe programs (NSP), medications for opioid use disorder (MOUD), and PrEP. Results We conducted interviews with 41 PWID. Most participants were relatively aware of their personal HIV risk and accurately identified situations that increased risk, including sharing needles and engaging in transactional sex. Despite risk awareness, participants described engaging in known HIV risk behaviors to satisfy immediate drug use needs. All reported knowledge of harm reduction services, especially distribution of sterile needles and syringes, and many reported having experience with MOUD. Participants who had accessed MOUD followed two primary trajectories; limited resources and relationships with other PWID caused them to discontinue treatment while desire to regain something they believed was lost to their drug use motivated them to continue. Overall, PrEP knowledge among participants was limited and few reported ever taking PrEP. However, participants supported integrating PrEP into harm reduction service delivery and advocated for changes in how these services are accessed. Stigma experienced in healthcare facilities and challenges acquiring money for transportation presented barriers to accessing current facility-based harm reduction and HIV prevention services. Conclusions Meeting the HIV prevention needs of PWID in Uganda will require lowering barriers to access, including integrated delivery of PrEP and harm reduction services and bringing services directly to communities. Additional training in providing patient-centered care for healthcare providers may improve uptake of facility-based services.

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“…The study population were partners of pregnant women who were attending ANC at Wakiso HCIV in Wakiso District. Male partners were targeted because the MoH rolled out HIVST at ANC clinics to have the partners of pregnant women tested for HIV at their convenience since they often had no time to accompany their pregnant women to ANC where they would have an opportunity to be tested and to minimize the spread of HIV infections among mothers and the un born babies [11,12]. The study excluded male partners whose telephone number was not provided in the HIVST distribution log book at the ANC by their pregnant woman before receiving the kit.…”

Section: Study Populationmentioning

confidence: 99%

Prevalence, Associated Factors, Barriers and Facilitators for Oral HIV Self-Testing among Partners of Pregnant Women Attending Antenatal Care Clinics in Wakiso, Uganda

Nduhukyire,

Semitala,

Mutanda

et al. 2024

Preprint

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Background Oral HIV self-testing (HIVST) among men is relatively low and still inadequate in Sub-Saharan Africa. Delivering HIVST kits by pregnant women attending antenatal care to their partners is a promising strategy for increasing HIV testing among men. However, even amidst the interventions, most men do not know their HIV status. This study, aimed to determine the proportion of partners who received and used oral HIVST kits delivered by pregnant women, associated factors, barriers, and facilitators for uptake among partners. Methods We conducted an exploratory sequential mixed methods study among 380 sampled partners. Lists of partners in the HIVST log books whose women picked an HIVST kit were obtained and systematic random sampling was done to obtain participants. 14 male partners were purposively selected for in-depth interviews (IDIs) to identify barriers and facilitators. We used modified poison regression to determine the association between oral HIVST and independent variables. We used an inductive analysis for the qualitative analysis. Results Out of 380 participants, 260(68.4%) received an oral HIVST kit from their pregnant women, and 215(82.7%) used the kit for HIVST. Oral HIVST was associated with; Information Education and Communication (CPR = 1.64, 95%CI 1.48–1.82), being reached at home (CPR = 1.04, 95%CI 1.01–1.08), and being aware of the woman’s HIV status (CPR = 1.04, 95%CI 0.99–1.09). In-depth results identified barriers to uptake as, lack of trust in the HIVST kit results, fear of test outcome in the presence of the partner and inclination that the HIV status of their women is the same as theirs, and facilitators included convenience, ease to use, prior awareness of their HIV status, and fear of relationship consequences and breakup. Conclusion Delivery of oral HIVST kits to men through pregnant women reached a high number of men and achieved a high uptake. Accessing information, education, communication and convenience nature were the major reasons for uptake among men who received the Oral HIVST kit as trust issues of the kit affected use among partners. Scaling up the delivery of oral HIVST kits at all departments of the hospital through women seeking health services is paramount to support HIV screening among men to reach the UNAIDS 95 strategy.

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How pregnant women living with HIV and their male partners manage men's HIV self‐testing: qualitative analysis of an HIVST secondary distribution process in Kampala, Uganda

Cited by 6 publications

References 31 publications

Effect of index HIV self-testing for sexual partners of clients enrolled in antiretroviral therapy (ART) programs in Malawi: A randomized controlled trial

Effect of index HIV self-testing for sexual partners of clients enrolled in antiretroviral therapy (ART) programs in Malawi: A randomized controlled trial

“Take services to the people”: strategies to optimize uptake of PrEP and harm reduction services among people who inject drugs in Uganda

Prevalence, Associated Factors, Barriers and Facilitators for Oral HIV Self-Testing among Partners of Pregnant Women Attending Antenatal Care Clinics in Wakiso, Uganda

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