Peer-leaders’ experiences and challenges in distributing HIV self-test kits in a rural fishing community, Rakai, Uganda

Abstract

Background Distribution of HIV self-test kits by trained lay people in the community has resulted in increased uptake of HIV testing services among the targeted populations. However, little data exists on the experiences and challenges faced by trained lay people while distributing the kits. Methods This qualitative study was conducted in Kasensero fishing community, Rakai, Uganda, in September 2019. We purposely selected 18 out of 34 peer-leaders that participated in a peer-led HIV self-testing intervention to participate in a post-intervention qualitative evaluation. The main intervention included identification and training of lay people in the community (‘peer-leaders’) to distribute HIV self-test kits to pre-selected members of their social network. Data for this study were collected at the end of the intervention. Data were collected on peer-leaders’ experiences in distributing the kits, challenges experienced during distribution and suggestions on how to improve peer-led HIV self-testing in typical fishing communities in the future. Data were analyzed manually following a thematic framework approach. Results Of the 18 peer-leaders, eleven (61.1%) were aged 20–24 years while thirteen (72.2%) had secondary education. Most (n = 15) of the peer-leaders reported that they found it easier to distribute the kits to their social network members, with most of them distributing the kits at the social network members’ homes or at their own homes. HIV self-test kits were distributed at varying times (e.g. in the afternoon) depending on the agreement reached between the peer-leader and their social network member. A few peer-leaders reported that some of their social network members initially hesitated to accept the kits while other peer-leaders reported that they spent a ‘lot of time’ explaining the HIV self-testing procedures to some of their illiterate members. Peer-leaders argued for supervised HIV self-testing for illiterate people and the need to continuously follow-up social network members to check if they tested for HIV. Conclusion A majority of the peer-leaders successfully distributed the kits to their social network members save for a few who experienced challenges. These findings suggest that lay people can be trained as effective HIV self-test kits distributors to improve the distribution of kits in the community.

Uptake and perceptions of oral HIV self-testing delivered by village health teams among men in Central Uganda: A concurrent parallel mixed methods analysis

“…Since HIVST was a relatively new testing approach in Uganda [31], some men had reservations similar to those reported by Njau et al [27] such as how to use the kit, resolving of potential occurrences of self or social harm especially in unsupervised HIVST, and access to post-test support following HIVST. Although these concerns are reported to deter implementation of HIVST [30,63,[65][66][67], our study did not register any negative occurrences linked to HIVST. Regarding the need for support after HIVST, our research showed that VHT-delivered HIVST accompanied by information leaflets had a positive influence on the utilization of the surrounding facility-based HIV prevention and treatment services [44].…”

Interventions connecting young people living in Africa to healthcare; a systematic review using the RE-AIM framework

“…How the strategies were combined and accessed differed for all 16 tested interventions. These included the following: facility counseling and testing ( 51 ); home-based counseling; and testing only ( 51 , 58 , 61 – 63 , 67 ), enhanced counseling ( 49 , 61 , 63 , 67 ), follow-up phone calls; and home visits enhanced counseling ( 44 , 50 , 54 , 59 ), referrals including the use of a referral logbook; and referrals made for re-linkage made for counseling; testing and care ( 49 , 50 , 55 , 56 , 59 , 63 ), mobile clinic ( 58 , 59 ), incentive reimbursement of transportation ( 45 , 52 , 53 ), escort ( 56 ), short message service (SMS) ( 53 ), community health campaigns ( 62 ), social network ( 62 ) and using HIVST ( 52 , 55 ).…”

“…It informs decisions to take towards future scale-up and dissemination of interventions. Some interventions that combined a mobile hybrid community-based testing strategy with a novel patient-centered, multicomponent linkage strategy resulted in high linkage rates, with half of all individuals in need of HIV care linked within one week of HIV testing and three-quarters linked within a year ( 45 , 58 , 61 , 67 ). This review method described participants’ characteristics, sample sizes, and representativeness in interventions to identify the target population.…”

Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study

“…Our study showed that those who initiated the referral process by completing the web-based training had good connections with other community members. They were confident in and accepted the use of blood-based self-tests and could therefore serve as the point of reference when their peers encountered problems performing self-tests [ 28 ]. On the other hand, the positive feedback illustrated by their high system usability scores incited them to refer their peers [ 29 ].…”