Drivers and barriers to workplace-based HIV self-testing among high-risk men in Uganda: a qualitative study

Patience A Muwanguzi,Robert C Bollinger,Laron E Nelson,José A Bauermeister,Stuart C Ray,Noah Kiwanuka,Nelson K Sewankambo

doi:10.1186/s12889-021-11041-y

Abstract

BackgroundMen in Sub-Saharan Africa are less engaged than women in accessing HIV testing and treatment and, consequently, experience higher HIV-related mortality. Reaching men with HIV testing services is challenging, thus, increasing the need for innovative ways to engage men with low access and those at higher risk. In this study, we explore men’s perceptions of drivers and barriers of workplace-based HIV self-testing in Uganda.MethodsAn exploratory study involving men working in private security companies employing more than 50 men in two districts, in central and western Uganda. Focus group discussions and key informant interviews were conducted. Data were analyzed using inductive content analysis.ResultsForty-eight (48) men from eight private security companies participated in 5 focus group discussions and 17 key informant interviews. Of the 48 men, 14(29.2%) were ages 26–35 years. The majority 31(64.6%) were security guards. The drivers reported for workplace-based HIV self-testing included convenience, autonomy, positive influence from work colleagues, the need for alternative access for HIV testing services, incentives, and involvement of employers. The barriers reported were the prohibitive cost of HIV tests, stigma, lack of testing support, the fear of discrimination and isolation, and concerns around decreased work productivity in the event of a reactive self-test.ConclusionsWe recommend the involvement of employers in workplace-based HIV self-testing to encourage participation by employees. There is need for HIV self-testing support both during and after the testing process. Both employers and employees recommend the use of non-monetary incentives, and regular training about HIV self-testing to increase the uptake and acceptability of HIV testing services at the workplace.

Highlights

Men in Sub-Saharan Africa are less engaged than women in accessing HIV testing and treatment and, experience higher HIV-related mortality
A few quantitative studies assessing workplace HIV self-testing as a way of engaging men in sub-Saharan Africa have been conducted, they have been limited to mining and farming industries in Malawi, Zambia and Zimbabwe [14], as well as truck drivers in Kenya [15]
Drivers and barriers to workplace-based HIV self-testing To elicit these responses, the participants responded to questions about the potential barriers to workplacebased HIV self-testing

Summary

Introduction

Men in Sub-Saharan Africa are less engaged than women in accessing HIV testing and treatment and, experience higher HIV-related mortality. A few quantitative studies assessing workplace HIV self-testing as a way of engaging men in sub-Saharan Africa have been conducted, they have been limited to mining and farming industries in Malawi, Zambia and Zimbabwe [14], as well as truck drivers in Kenya [15]. While these studies reported high acceptability, they did not provide information regarding the facilitators or barriers of this approach, nor provide insights into the approaches to increase uptake of HIV self-testing in work settings. The truckers, farmers and miners are largely mobile populations, there is a gap in information on workplace-based HIV self-testing among men in more stable employment

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