Abstract
BackgroundDespite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care in Kasensero fishing community in rural Uganda.MethodsThis qualitative study was conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, in May 2019. Six single-sex focus group discussions (FGDs) comprising 7–8 participants were conducted with adolescents and young people (15–24 years) and adult men (25+ years). We collected data on people’s perceptions about peer-led HIVST; potential acceptability of a peer-led HIVST intervention and suggestions on how to improve linkage to HIV care after a positive HIVST result. Peer-led HIVST was defined as an approach where trained lay people distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach.ResultsForty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the fishing community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience. To improve linkage to HIV care, participants felt that the use of peer-leaders to deliver the initial ART dose to self-tested HIV-positive individuals would be more preferable to the use of community-based ART groups or home-based ART initiation.ConclusionOur study shows that peer-led HIVST is potentially acceptable in the fishing community. These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services.
Highlights
Despite efforts to improve Human Immunodeficiency Virus (HIV) testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets
These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services
Our study found that favourable attitudes towards the implementation of a peer-led HIV self-testing (HIVST) intervention in the fishing community
Summary
Despite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. Results from population-based HIV impact assessments in Malawi, Zambia and Zimbabwe show that 48% of adolescents and young people (15–24 years) living with HIV were aware of their HIV status in 2017 compared to 65% of those aged 25–34 years and 78% of those aged 35–59 years [5]. Similar barriers continue to inhibit HIV testing uptake among adult men, including fear for testing positive for HIV, stigma associated with HIV, and fear that their HIV-positive results may not be kept confidential by health workers [12], and call for a need to design interventions that can reduce these barriers in order to improve HIV testing coverage and linkage to HIV care among adolescents, young people and adult men who are often missed in HIV testing and treatment programs [13, 14]
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