Perspectives on voluntary assisted partner notification among providers, people with HIV and the general population in Indonesia: a formative qualitative study

Gede Benny Setia Wirawan,I Gusti Agung Agus Mahendra,Cheryl Johnson,Pande Putu Januraga,Bharat Bhushan Rewari,Ngakan Putu Anom Harjana,Tiara Mahatmi,David A Katz,Lanny Luhukay

doi:10.1186/s12889-021-10332-8

Abstract

BackgroundVoluntary assisted partner notification (aPN) services are effective in increasing access to and uptake of HIV testing among partners of people with HIV. Following recommendations by the World Health Organization in 2016, Indonesia evaluated various approaches to aPN. We present the lessons learned from formative operational research undertaken to understand provider and patient perspectives on aPN from three demonstration sites in cities with a high HIV burden.MethodsWe conducted a formative qualitative study in three cities: Jakarta, Semarang, and Denpasar between September and October 2019. We conducted six focus group discussions (FGDs) (n = 44 participants) among health-care providers, people living with HIV and the general population. We explored participant preferences and concerns about how aPN should be delivered, including the methods of and messaging for contacting partners. All FGDs were conducted in the Indonesian language. Qualitative data were analysed using thematic analysis.ResultsaPN was acceptable across different participant populations, although with caveats. Some differences were observed between the general population, providers and people living with HIV. People living with HIV were mainly concerned with confidentiality of the procedure and preferred the use of telecommunication and messages that avoid explicit mention of HIV exposure. Providers preferred similar approaches but for different reasons, being concerned mainly with self-efficacy and security. There was consensus regarding dual referral models. The use of phone calls and short messages were preferred as these are perceived to minimize negative reactions and stigma, protect client confidentiality and are suitable in the current legal situation. The general population was mainly concerned with effectiveness and prefer direct provider-led approaches, such as preferring in-person meeting with explicit notification of potential HIV exposure.ConclusionsWe found consensus among stakeholders on acceptance of aPN, especially dual referral methods. Development and implementation of aPN protocols should also consider clients’ individual situations and concerns regarding safeguarding of confidentiality, and offer a range of options to accommodate all stakeholders involved.

Highlights

Voluntary assisted partner notification services are effective in increasing access to and uptake of HIV testing among partners of people with HIV
We aimed to explore the perceptions of assisted partner notification (aPN) among the general population, people are living with HIV (PLHIV) and health-care providers, and identify preferences for and barriers to effective services
There were some variations in preference regarding how to approach PLHIV and establish contact with their partners

Summary

Introduction

Voluntary assisted partner notification (aPN) services are effective in increasing access to and uptake of HIV testing among partners of people with HIV. Efforts have been made to increase access to HIV testing, prevention and treatment through integration of HIV care from prevention, testing and treatment through the “Layanan Komprehensif Berkesinambungan” (i.e. continuum of care) Barriers such as lack of knowledge of HIV, poor risk perception, stigma and suboptimal access to care continue to hinder efforts to increase coverage, for those most affected by HIV [5,6,7,8,9]. To address this gap, in 2019, the Indonesian government prioritized innovations for HIV testing services by initiating the development of a voluntary assisted partner notification (aPN) programme

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