Messaging Circumstances and Economic Pressures as Influences on Linkage to Medical Male Circumcision following Community-Based HIV Testing for Men in Rural Southwest Uganda: A Qualitative Study.

Hannah N Gilbert,Stephen Asiimwe,Elioda Tumwesigye,Heidi Van Rooyen,Ruanne V Barnabas,Bosco Turyamureeba,Connie L Celum,Norma C Ware,Monique A Wyatt

doi:10.1155/2018/8387436

Abstract

Voluntary medical male circumcision (MMC) reduces risk of HIV infection, but uptake remains suboptimal among certain age groups and locations in sub-Saharan Africa. We analysed qualitative data as part of the Linkages Study, a randomized controlled trial to evaluate community-based HIV testing and follow-up as interventions promoting linkage to HIV treatment and prevention in Uganda and South Africa. Fifty-two HIV-negative uncircumcised men participated in the qualitative study. They participated in semistructured individual interviews exploring (a) home HTC experience; (b) responses to test results; (c) efforts to access circumcision services; (d) outcomes of efforts; (e) experiences of follow-up support; and (f) local HIV education and support. Interviews were audio-recorded, translated, transcribed, and summarized into “linkage summaries.” Summaries were analysed inductively to identify the following three thematic experiences shaping men's circumcision choices: (1) intense relief upon receipt of an unanticipated seronegative diagnosis, (2) the role of peer support in overcoming fear, and (3) anticipation of missed economic productivity. Increased attention to the timing of demand creation activities, to who delivers information about the HIV prevention benefits of MMC, and to the importance of missed income during recovery as a barrier to uptake promises to strengthen and sharpen future MMC demand creation strategies.

Highlights

Linkage to antiretroviral treatment and effective prevention following widespread testing promises to reduce HIV incidence in Africa
Based upon qualitative data collected as part of the Linkages Study, this paper describes key experiences impacting uncircumcised Ugandan men’s interest in and ability to pursue male circumcision (MMC) following a negative HIV test result
Forty percent (N = 21) had been randomized to counsellor follow-up for linkage to MMC services following home HIV testing; 54% were assigned to follow-up through text messages

Summary

Introduction

Linkage to antiretroviral treatment and effective prevention following widespread testing promises to reduce HIV incidence in Africa. A number of strategies to increase linkage are being evaluated, including integration and “streamlining” of services, point of care CD4 and viral load testing, economic incentives, and community-based testing with counselling and follow-up support [1,2,3,4,5,6]. The efficacy of voluntary medical male circumcision (MMC) in reducing the risk of HIV infection has been demonstrated in three randomized controlled clinical trials (RCTs) in Africa. These RCTs revealed a nearly 60% reduction in female-to-male HIV transmission [7,8,9].

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Results

Conclusion