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Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi

BACKGROUND: Assisted index case testing, in which health care workers take an active role in referring at-risk contacts of people living with HIV for HIV testing services, has been widely recognized as an evidence-based intervention with high potential to increase PLHIV status awareness. Promising e...

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Autores principales: Meek, Caroline J., Munkhondya, Tiwonge E. Mbeya, Mphande, Mtisunge, Tembo, Tapiwa A., Chitani, Mike, Jean-Baptiste, Milenka, Vansia, Dhrutika, Kumbuyo, Caroline, Simon, Katherine R., Rutstein, Sarah E., Barrington, Clare, Kim, Maria H., Go, Vivian F., Rosenberg, Nora E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Journal Experts 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503858/
https://www.ncbi.nlm.nih.gov/pubmed/37720011
http://dx.doi.org/10.21203/rs.3.rs-3314925/v1
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author Meek, Caroline J.
Munkhondya, Tiwonge E. Mbeya
Mphande, Mtisunge
Tembo, Tapiwa A.
Chitani, Mike
Jean-Baptiste, Milenka
Vansia, Dhrutika
Kumbuyo, Caroline
Simon, Katherine R.
Rutstein, Sarah E.
Barrington, Clare
Kim, Maria H.
Go, Vivian F.
Rosenberg, Nora E.
author_facet Meek, Caroline J.
Munkhondya, Tiwonge E. Mbeya
Mphande, Mtisunge
Tembo, Tapiwa A.
Chitani, Mike
Jean-Baptiste, Milenka
Vansia, Dhrutika
Kumbuyo, Caroline
Simon, Katherine R.
Rutstein, Sarah E.
Barrington, Clare
Kim, Maria H.
Go, Vivian F.
Rosenberg, Nora E.
author_sort Meek, Caroline J.
collection PubMed
description BACKGROUND: Assisted index case testing, in which health care workers take an active role in referring at-risk contacts of people living with HIV for HIV testing services, has been widely recognized as an evidence-based intervention with high potential to increase PLHIV status awareness. Promising evidence for the approach has led to several attempts to scale assisted index case testing throughout eastern and southern Africa in recent years. However, despite effective implementation being at the heart of any assisted index case testing strategy, there is limited implementation science research from the perspective of the HCWs who are doing the “assisting”. This study examines the feasibility of assisted index case testing from the perspective of health care workers implementing the approach in Malawi. METHODS: In-depth interviews were conducted with 26 lay health care workers delivering assisted index case testing in Malawian health facilities. Interviews explored health care workers’ experiences counselling index clients and tracing these clients’ contacts, aiming to inform development of a blended learning implementation package. Transcripts were inductively analyzed using Dedoose coding software to identify and describe key factors influencing feasibility of assisted index case testing. Analysis included multiple rounds of coding and iteration with the data collection team. RESULTS: Participants reported a variety of barriers to feasibility of assisted index case testing implementation, including privacy concerns, limited time for assisted index case testing amid high workloads, poor quality contact information, logistical obstacles to tracing, and challenges of discussing sexual behavior with clients. Participants also reported several health care worker characteristics that facilitate feasibility: robust understanding of assisted index case testing’s rationale and knowledge of procedures, strong interpersonal skills, positive attitudes towards clients, and sense of purpose in their work. CONCLUSIONS: Findings demonstrate that maximizing assisted index case testing’s potential to increase HIV status awareness requires adequately equipping health care workers with appropriate knowledge, skills, and support to address and overcome the many feasibility challenges that they face in implementation. TRIAL REGISTRATION NUMBER: NCT05343390 Date of registration: April 25, 2022
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spelling pubmed-105038582023-09-16 Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi Meek, Caroline J. Munkhondya, Tiwonge E. Mbeya Mphande, Mtisunge Tembo, Tapiwa A. Chitani, Mike Jean-Baptiste, Milenka Vansia, Dhrutika Kumbuyo, Caroline Simon, Katherine R. Rutstein, Sarah E. Barrington, Clare Kim, Maria H. Go, Vivian F. Rosenberg, Nora E. Res Sq Article BACKGROUND: Assisted index case testing, in which health care workers take an active role in referring at-risk contacts of people living with HIV for HIV testing services, has been widely recognized as an evidence-based intervention with high potential to increase PLHIV status awareness. Promising evidence for the approach has led to several attempts to scale assisted index case testing throughout eastern and southern Africa in recent years. However, despite effective implementation being at the heart of any assisted index case testing strategy, there is limited implementation science research from the perspective of the HCWs who are doing the “assisting”. This study examines the feasibility of assisted index case testing from the perspective of health care workers implementing the approach in Malawi. METHODS: In-depth interviews were conducted with 26 lay health care workers delivering assisted index case testing in Malawian health facilities. Interviews explored health care workers’ experiences counselling index clients and tracing these clients’ contacts, aiming to inform development of a blended learning implementation package. Transcripts were inductively analyzed using Dedoose coding software to identify and describe key factors influencing feasibility of assisted index case testing. Analysis included multiple rounds of coding and iteration with the data collection team. RESULTS: Participants reported a variety of barriers to feasibility of assisted index case testing implementation, including privacy concerns, limited time for assisted index case testing amid high workloads, poor quality contact information, logistical obstacles to tracing, and challenges of discussing sexual behavior with clients. Participants also reported several health care worker characteristics that facilitate feasibility: robust understanding of assisted index case testing’s rationale and knowledge of procedures, strong interpersonal skills, positive attitudes towards clients, and sense of purpose in their work. CONCLUSIONS: Findings demonstrate that maximizing assisted index case testing’s potential to increase HIV status awareness requires adequately equipping health care workers with appropriate knowledge, skills, and support to address and overcome the many feasibility challenges that they face in implementation. TRIAL REGISTRATION NUMBER: NCT05343390 Date of registration: April 25, 2022 American Journal Experts 2023-09-08 /pmc/articles/PMC10503858/ /pubmed/37720011 http://dx.doi.org/10.21203/rs.3.rs-3314925/v1 Text en https://creativecommons.org/licenses/by/4.0/This work is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/) , which allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.
spellingShingle Article
Meek, Caroline J.
Munkhondya, Tiwonge E. Mbeya
Mphande, Mtisunge
Tembo, Tapiwa A.
Chitani, Mike
Jean-Baptiste, Milenka
Vansia, Dhrutika
Kumbuyo, Caroline
Simon, Katherine R.
Rutstein, Sarah E.
Barrington, Clare
Kim, Maria H.
Go, Vivian F.
Rosenberg, Nora E.
Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi
title Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi
title_full Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi
title_fullStr Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi
title_full_unstemmed Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi
title_short Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi
title_sort examining the feasibility of assisted index case testing for hiv case-finding: a qualitative analysis of barriers and facilitators to implementation in malawi
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503858/
https://www.ncbi.nlm.nih.gov/pubmed/37720011
http://dx.doi.org/10.21203/rs.3.rs-3314925/v1
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