HIV Positive status disclosure to sexual partners: a qualitative study to explore experiences and challenges among clients attending HIV care services in North-Western Tanzania

Ethiopia’s performance toward the UNAIDS 90-90-90 targets is low. The present study explored interventions to improve delayed HIV care presentation (first 90), poor retention (second 90) and clinical and immunological failure (third 90). We employed a qualitative approach using in-depth interviews with 10 HIV patients, nine health workers, 11 community advocates and five HIV program managers. Ethical approvals were obtained from Australia and Ethiopia. The following were suggested solutions to improve HIV care and treatment to meet the three 90s: (i) strengthening existing programs including collaboration with religious leaders; (ii) implementing new programs such as self-HIV testing, house-to-house HIV testing, community antiretroviral therapy (ART) distribution and teach-test-treat-link strategy; (iii) decentralizing and integrating services such as ART in health post and in private clinics, and integrating HIV care services with mental illness and other non-communicable diseases; and (iv) filling gaps in legislation in issues related with HIV status disclosure and traditional healing practices. In conclusion, the study suggested important solutions for improving delayed HIV care presentation, attrition, and clinical and immunological failure. A program such as the teach-test-treat-link strategy was found to be a cross-cutting intervention to enhance the three 90s. We recommend further nationwide research before implementing the interventions.

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Challenges of HIV Self-Test Distribution for Index Testing When HIV Status Disclosure Is Low: Preliminary Results of a Qualitative Study in Bamako (Mali) as Part of the ATLAS Project

Frontiers in Public Health ◽

10.3389/fpubh.2021.653543 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sokhna Boye ◽

Seydou Bouaré ◽

Odette Ky-Zerbo ◽

Nicolas Rouveau ◽

Arlette Simo Fotso ◽

...

Keyword(s):

Qualitative Study ◽

Health Professionals ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Status ◽

Preliminary Results ◽

Research Activities ◽

Medical Consultations ◽

Hiv Status Disclosure ◽

Status Disclosure

Context: The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). The AutoTest-VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners.Methods: This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis.Results: HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIVST distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status.Conclusion: It is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.

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Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

10.21203/rs.2.14292/v2 ◽

2019 ◽

Author(s):

Samuel Lawrent Mpinganjira ◽

Timothy Tchereni ◽

Andrews Gunda ◽

Victor Mwapasa

Keyword(s):

Qualitative Study ◽

Health Facilities ◽

System Level ◽

Hiv Care ◽

Hiv Positive ◽

Long Distance ◽

Care Clinic ◽

Loss To Follow Up ◽

Factors Associated

Abstract Background In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced 19 LTFU women and conducted in-depth interviews with them and also with 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed and translated and, then, analysed using deductive content analysis. Results The following reasons were reported contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; food insecurity; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system level which contribute to poor retention of mother-infant pairs in HIV care. Key words PRIME, PMTCT, EMTCT, loss to follow up, mother-infant pairs, Option B+

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Disclosure of HIV seropositivity to sexual partner in Ethiopia: A systematic review

Women s Health ◽

10.1177/17455065211063021 ◽

2021 ◽

Vol 17 ◽

pp. 174550652110630

Author(s):

Aklilu Endalamaw ◽

Yibeltal Assefa ◽

Demeke Geremew ◽

Habte Belete ◽

Berihun Assefa Dachew ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Sexual Partners ◽

Hiv Positive ◽

People Living With Hiv ◽

Hiv Status ◽

Living With Hiv ◽

Status Disclosure ◽

The Impact

Introduction: In Ethiopia, the burden of HIV/AIDS is a public health issue that requires significant control of transmission. Once an infection has been established, determinants influence people living with HIV to disclose or not their HIV-positive status to sexual partners. This study assessed the proportion and associated factors of people living with HIV’s disclosure status to sexual partners. Methods: CRD42020149092 is the protocol’s registration number in the PROSPERO database. We searched PubMed, Scopus, African Journals Online, and Google Scholar databases. For the subjective and objective assessment of publication bias, we used a funnel plot and Egger’s regression test, respectively. The I2 statistic was used to assess variation across studies. Meta-analysis of weighted inverse variance random-effects model was used to estimate the pooled proportion. We conducted subgroup and sensitivity analyses to investigate the cause of heterogeneity and the impact of outliers on the overall estimation, respectively. A trend analysis was also performed to show the presence of time variation. Results: The percentage of people living with HIV who disclosed their HIV-positive status to sexual partners was 76.03% (95% confidence interval: 68.78, 83.27). Being on antiretroviral therapy (adjusted odds ratio = 6.19; 95% confidence interval: 2.92, 9.49), cohabiting with partner (adjusted odds ratio = 4.48; 95% confidence interval: 1.24, 7.72), receiving HIV counseling (adjusted odds ratio = 3.94; 95% confidence interval: 2.08, 5.80), having discussion prior to HIV testing (adjusted odds ratio = 4.40; 95% confidence interval: 2.11, 6.69), being aware of partner’s HIV status (adjusted odds ratio = 6.08; 95% confidence interval: 3.05, 9.10), positive relationship with partner (adjusted odds ratio = 4.44; 95% confidence interval:1.28, 7.61), and being member of HIV association (adjusted odds ratio = 3.70; 95% confidence interval: 2.20, 5.20) had positive association with HIV status disclosure. Conclusion: In Ethiopia, more than one-fourth of adults living with HIV did not disclose their HIV-positive status to sexual partners. HIV-positive status disclosure was influenced by psychosocial factors. A multidimensional approach is required to increase seropositive disclosure in Ethiopia.

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Barriers and Facilitators of Linkage to and Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study

AIDS Patient Care and STDs ◽

10.1089/apc.2015.0296 ◽

2016 ◽

Vol 30 (2) ◽

pp. 70-77 ◽

Cited By ~ 32

Author(s):

Yu Liu ◽

Chandra Y. Osborn ◽

Han-Zhu Qian ◽

Lu Yin ◽

Dong Xiao ◽

...

Keyword(s):

Qualitative Study ◽

Barriers And Facilitators ◽

Hiv Care ◽

Hiv Positive ◽

Sex With Men ◽

Engagement In Hiv Care ◽

Hiv Positive Men

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A qualitative study of Thai HIV-positive young men who have sex with men and transgender women demonstrates the need for eHealth interventions to optimize the HIV care continuum

AIDS Care ◽

10.1080/09540121.2017.1286288 ◽

2017 ◽

Vol 29 (7) ◽

pp. 870-875 ◽

Cited By ~ 16

Author(s):

Tarandeep Anand ◽

Chattiya Nitpolprasert ◽

Stephen J. Kerr ◽

Kathryn E. Muessig ◽

Sangusa Promthong ◽

...

Keyword(s):

Qualitative Study ◽

Young Men ◽

Transgender Women ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Care Continuum ◽

Care Continuum ◽

Sex With Men

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Discussing parenthood with gay men diagnosed with HIV: a qualitative study of patient and healthcare practitioner perspectives

BMC Public Health ◽

10.1186/s12889-021-12285-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Robert Pralat ◽

Jane Anderson ◽

Fiona Burns ◽

Elizabeth Yarrow ◽

Tristan J. Barber

Keyword(s):

Qualitative Study ◽

Gay Men ◽

Thematic Analysis ◽

Qualitative Interviews ◽

Hiv Care ◽

Hiv Positive ◽

Heterosexual Men ◽

Healthcare Practitioner ◽

Beneficial Effects ◽

Living With Hiv

Abstract Background Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate. Methods Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20–45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care. Results Two sets of ideas contributed to a lack of conversations about parenthood: clinicians’ ideas about what matters to gay men and men’s ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV. Conclusions Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients’ gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.

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How Follow-Up Counselling Increases Linkage to Care Among HIV-Positive Persons Identified Through Home-Based HIV Counselling and Testing: A Qualitative Study in Uganda

SAGE Open ◽

10.1177/2158244019900166 ◽

2020 ◽

Vol 10 (1) ◽

pp. 215824401990016

Author(s):

Dominic Bukenya ◽

Janet Seeley ◽

Grace Tumwekwase ◽

Elizabeth Kabunga ◽

Eugene Ruzagira

Keyword(s):

Qualitative Study ◽

Partner Violence ◽

Linkage To Care ◽

Hiv Treatment ◽

Hiv Care ◽

Hiv Positive ◽

Accurate Information ◽

Home Based ◽

Linkage To Hiv Care

We investigated how follow-up counselling had increased linkage to HIV care in a trial of referral to care and follow-up counseling, compared to referral to care only, for participants diagnosed as HIV-positive through home-based HIV counseling and testing. We carried out a cross-sectional qualitative study. Using random stratified sampling, we selected 43 trial participants (26 [60%] in the intervention arm). Sample stratification was by sex, distance to an ART facility, linkage, and nonlinkage to HIV care. Twenty-six in-depth interviews were conducted with participants in the intervention arm: 17 people who had linked to HIV care and 9 who had not linked after 6 months of follow-up. Home-based follow-up counseling helped to overcome worries resulting from an HIV-positive test result. In addition, the counseling offered an opportunity to address questions on HIV treatment side effects, share experiences of intimate partner violence or threats, and general problems linking to care. The counselling encouraged early linkage to HIV care and use of biomedical medicines, discouraging alternative medicine usage. Home-based follow-up counseling also helped to promote HIV sero-status disclosure, facilitating linkage to, retention in and adherence to HIV care and treatment. This study successfully demonstrated that home-based follow-up counselling increased linkage to care through encouragement to seek care, provision of accurate information about HIV care services and supporting the person living with HIV to disclose and manage stigma.

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