Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.

Download Full-text

Provider-Initiated HIV Testing and Counseling: Increased Uptake in Two Public Community Health Centers in South Africa and Implications for Scale-Up

PLoS ONE ◽

10.1371/journal.pone.0027293 ◽

2011 ◽

Vol 6 (11) ◽

pp. e27293 ◽

Cited By ~ 33

Author(s):

Shona Dalal ◽

Chung-won Lee ◽

Thato Farirai ◽

Allison Schilsky ◽

Thurma Goldman ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Community Health ◽

Community Health Centers ◽

Scale Up ◽

Health Centers ◽

Hiv Testing And Counseling ◽

Testing And Counseling

Download Full-text

Conformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Uganda

10.7287/peerj.preprints.27006 ◽

2018 ◽

Author(s):

Mari Armstrong-Hough ◽

Amanda J Meyer ◽

Achilles Katamba ◽

J. Lucian Davis

Keyword(s):

Decision Making ◽

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

First Person ◽

Home Based ◽

Group Members ◽

Household Members ◽

Individual Decisions

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.

Download Full-text

Conformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Uganda

10.7287/peerj.preprints.27006v1 ◽

2018 ◽

Author(s):

Mari Armstrong-Hough ◽

Amanda J Meyer ◽

Achilles Katamba ◽

J. Lucian Davis

Keyword(s):

Decision Making ◽

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

First Person ◽

Home Based ◽

Group Members ◽

Household Members ◽

Individual Decisions

Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used to generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.

Download Full-text

“If it is left, it becomes easy for me to get tested”: Use of oral self‐tests and community health workers to maximize the potential of home‐based HIV testing among adolescents in Lesotho

Journal of the International AIDS Society ◽

10.1002/jia2.25563 ◽

2020 ◽

Vol 23 (S5) ◽

Author(s):

Alain Amstutz ◽

Mathebe Kopo ◽

Thabo I Lejone ◽

Lefu Khesa ◽

Mpho Kao ◽

...

Keyword(s):

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Home Based

Download Full-text

Knowledge and Perceptions of People Living With HIV Regarding The HIV Services That Are Offered By The Community Health Workers in KwaZulu-Natal, South Africa

10.21203/rs.3.rs-246112/v1 ◽

2021 ◽

Author(s):

Gugulethu Eve Khumalo ◽

Bontle Segobe ◽

Elizabeth Lutge ◽

Tivani P Mashamba-Thompson

Keyword(s):

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

P Value ◽

People Living With Hiv ◽

Positive Perception ◽

Hiv Services ◽

Kwazulu Natal ◽

Living With Hiv

Abstract Background: KwaZulu-Natal (KZN) is the province with the highest HIV prevalence in South Africa (SA). Community Health Workers (CHWs) are key to delivery of HIV services at community level. Evidence on knowledge and perceptions of people living with HIV (PLWH) regarding the HIV services that are offered by the CHWs is limited. Therefore, this study seeks to determine knowledge and perceptions of PLWH regarding the HIV services that are offered by the CHWs in KZN.Methods: The study design was a quantitative survey using an administrator-administered questionnaire. A total of 303 PLWH from 3 selected KZN clinics were interviewed to determine their knowledge and perceptions of HIV services offered by the CHWs. Statistical Package for Social Sciences (SPSS) version 27 was used to describe the population and testing for associations between variables. The significant level was set at a p value ≤ 0.05 and at 95% confidence internal.Results: Among the 303 PLWH surveyed, 24 (8%), knew about the HIV services offered by the CHWs and of the 89 (29%) participants that were visited by CHWs, 73 (82%) had a positive perception about these services. Participants who were visited by a CHW were more likely (OR=1.57, 95% CI: 0.57-4.35) to know about the HIV services. Knowledge of HIV services was significantly associated with the positive perception of the HIV services (p<0.05). Knowledge and perception of the HIV services was not associated with age, gender, level of education or duration of visiting the clinic.Conclusion: The majority of PLWH in KZN have poor knowledge of HIV services offered by the CHWs and most of them have never been visited by a CHW in their homes. Those that were visited by CHWs were more likely to have positive perceptions regarding their HIV services. The findings of the study should trigger the scaling up of HIV community targeted initiatives that are delivered by CHWs in order to curb the HIV epidemic in the province.

Download Full-text

Post-trial perceptions of a symptom-based TB screening intervention in South Africa: implementation insights and future directions for TB preventive healthcare services

BMC Nursing ◽

10.1186/s12912-021-00544-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Nicole Salazar-Austin ◽

Minja Milovanovic ◽

Nora S. West ◽

Molefi Tladi ◽

Grace Link Barnes ◽

...

Keyword(s):

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Implementation Strategies ◽

Healthcare Services ◽

Preventive Therapy ◽

Provider Perceptions ◽

Symptom Screening ◽

Study Implementation

Abstract Background Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts. Methods Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants’ experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted. Results Participants’ had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers. Conclusions Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care. Trial registration The results presented here were from research related to NCT03074799, retrospectively registered on 9 March 2017.

Download Full-text